MPU3313/MPU2313 HEALTH AND WELLNESS Prof Dr Sha’ari Abd. Hamid Assoc Prof Raijah Rahim Rames Prasath Mahatam Rai Rosnida Abu Bakar
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Project Directors:
Prof Dato’ Dr Mansor Fadzil Prof Dr Faridah Hashim Open University Malaysia
Module Writers:
Prof Dr Sha’ari Abd. Hamid Assoc Prof Raijah Rahim Rames Prasath Mahatam Rai Rosnida Abu Bakar Open University Malaysia
Moderator:
Prof Dr Faridah Hashim Open University Malaysia
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First Edition, December 2015 Copyright © Open University Malaysia (OUM), December 2015, MPU3313/MPU2313 All rights reserved. No part of this work may be reproduced in any form or by any means without the written permission of the President, Open University Malaysia (OUM).
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Table of Contents Course Guide Topic 1
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Concept of Health and Wellness 1.1 Meaning of Health 1.2 Meaning of Wellness 1.3 Characteristics of a Healthy Lifestyle 1.3.1 Personal Responsibility for Health and Wellness 1.4 Influences on Health and Wellness 1.4.1 Predisposing Factors 1.4.2 Reinforcing Factors 1.4.3 Barriers to Wellness 1.4.4 Lifestyle Influences 1.5 Benefits of a Comprehensive Health and Wellness Lifestyle 1.5.1 Improved Cardiovascular or Heart and Blood Vessels Efficiency 1.5.2 Increased Muscle Tone, Strength, Flexibility and Endurance 1.5.3 Improved Self-control, Self-efficacy and Self-esteem 1.5.4 Improved Stress Management and Outlook in Life 1.5.5 Improved Interpersonal Relationships 1.5.6 Decreased Mortality and Morbidity from Illnesses 1.6 Conclusion Summary Key Terms References
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TABLE OF CONTENTS
Topic 2
Dimensions of Health and Wellness I 2.1 Dimensions of Health and Wellness 2.2 Physical Dimension 2.2.1 What is Physical Fitness? 2.2.2 Developing a Cardiorespiratory Fitness Programme 2.3 Emotional Dimension 2.3.1 Emotional Stability 2.3.2 Self-concept 2.4 Spiritual Dimension 2.5 Intellectual Dimension Summary Key Terms References
24 25 28 30 31 33 34 35 37 39 41 42 43
Topic 3
Dimensions of Health and Wellness II 3.1 Social Dimension 3.2 Occupational Dimension 3.3 Environmental Dimension 3.4 Financial Dimension 3.4.1 The Impetus that Led to the Creation of a Financial Wellness Programme 3.4.2 Financial Wellness at the Workplace Summary Key Terms References
44 45 50 54 58
Understanding Nutrition and Diet 4.1 Components of Healthy Diet 4.1.1 Proteins 4.1.2 Carbohydrates 4.1.3 Fats 4.1.4 Vitamins 4.1.5 Minerals 4.1.6 Water 4.1.7 Dietary Challenges for Special Groups 4.2 Healthy versus Therapeutic Diet 4.2.1 Healthy Diet 4.2.2 Therapeutic Diet Summary Key Terms References
63 65 66 67 69 71 74 74 75 77 77 80 84 85 85
Topic 4
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Topic 5
Maintaining Weight 5.1 Basic Concepts of Weight Management 5.1.1 Body Mass Index (BMI) 5.1.2 Body Composition 5.2 Obesity 5.3 Eating Disorders 5.3.1 Anorexia Nervosa 5.3.2 Bulimia Nervosa 5.4 Weight Management Techniques Summary Key Terms References
87 88 88 90 92 95 96 98 99 102 103 104
Topic 6
Preventing Diseases 6.1 Importance of Disease Prevention 6.2 Cardiovascular Diseases 6.2.1 Understanding the Heart 6.2.2 Risk Factors that Cause Coronary Heart Disease (CHD) 6.2.3 Seriousness of Coronary Heart Disease 6.2.4 Signs and Symptoms of Coronary Heart Disease 6.2.5 Preventing Coronary Heart Disease 6.3 Understanding Cancer 6.3.1 What is Cancer? 6.3.2 Common Types of Cancer 6.3.3 Risk Factors for Cancer 6.3.4 Signs and Symptoms of Cancer 6.3.5 Prevention Strategies for Cancer 6.4 Understanding Diabetes Mellitus 6.4.1 Causes of Diabetes Mellitus 6.4.2 Classification of Diabetes Mellitus 6.4.3 Risk Factors of Diabetes Mellitus 6.4.4 Prevention of Diabetes Mellitus 6.5 Osteoporosis 6.5.1 Risk Factors for Osteoporosis 6.5.2 Prevention Strategies for Osteoporosis
105 106 108 108
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Topic 7
6.6
Kidney Disease 6.6.1 Common Causes of Kidney Disease 6.6.2 Signs and Symptoms of Kidney Disease 6.6.3 Risk Factors for Kidney Disease 6.6.4 Prevention of Kidney Disease Summary Key Terms References
124 125 126 126 127 131 133 134
Financial Health and Wellness 7.1 Financial Health and Wellness 7.1.2 Importance of Financial Wellness in the Context of OneÊs Total Health 7.2 Challenges to Financial Wellness 7.2.1 Economic Challenges 7.2.2 Other Challenges 7.2.3 Contributing Factors to Delayed Adulthood 7.3 Elements of Financial Wellness 7.4 Financial Fitness Summary Key Terms References
135 136
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COURSE GUIDE
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COURSE GUIDE
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COURSE GUIDE DESCRIPTION You must read this Course Guide carefully from the beginning to the end. It tells you briefly what the course is about and how you can work your way through the course material. It also suggests the amount of time you are likely to spend in order to complete the course successfully. Please keep on referring to the Course Guide as you go through the course material as it will help you to clarify important study components or points that you might miss or overlook.
INTRODUCTION MPU3313/MPU2313 Health and Wellness is one of the courses offered by Faculty of Nursing and Allied Health Sciences at Open University Malaysia (OUM). This course is worth 3 credit hours course and should covered over 8 to 15 weeks.
COURSE AUDIENCE This course is a compulsory course for all learners of OUM. As an open and distance learner, you should be acquainted with learning independently and being able to optimise the learning modes and environment available to you. Before you begin this course, please ensure that you have the right course material, and understand the course requirements as well as how the course is conducted.
STUDY SCHEDULE It is a standard OUM practice that learners accumulate 40 study hours for every credit hour. As such, for a three-credit hour course, you are expected to spend 120 study hours. Table 1 gives an estimation of how the 120 study hours could be accumulated.
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Table 1: Estimation of Time Accumulation of Study Hours Study Activities
Study Hours
Briefly go through the course content and participate in initial discussions
3
Study the module
60
Attend 3 to 5 tutorial sessions
10
Online participation
12
Revision
15
Assignment(s), Test(s) and Examination(s)
20
TOTAL STUDY HOURS ACCUMULATED
120
COURSE OUTCOMES By the end of this course, you should be able to: 1.
Explain the concept of health and wellness;
2.
Discuss the eight dimensions of health and wellness;
3.
Plan diet according to nutritional needs;
4.
Recommend the ideal body weight management;
5.
Select strategies to prevent common diseases; and
6.
Summarise what is meant by the term financial wellness.
COURSE SYNOPSIS This course is divided into seven topics. The synopsis for each topic can be listed as follows: Topic 1 introduces the learners to the basic concept of health and wellness, characteristics of a healthy lifestyle and personal responsibility to maintain health and wellness. As a learner, you will have the opportunity to plan for personal health and wellness improvement based on individual scores for the healthy lifestyle.
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Topic 2 focuses on the first four dimensions of health and wellness; physical, emotional, spiritual and intellectual. In this topic, learners will be exposed to examples of physical activities that contribute to physical wellness. Hopefully, the lesson will help learners to plan the strategies for emotional wellness, achieve spiritual support as well as recognise the importance of intellectual dimension in health and wellness. Topic 3 concentrates on the other four dimensions of health and wellness which are social, occupational, environmental and financial. It also explains some strategies to enhance social wellness. It is hoped that you can identify the factors that contribute to occupational wellness as well as your personal responsibility to promote environmental awareness. Last but not least, basic understanding on personal management of financial matters is also available in this topic. Topic 4 highlights the component of healthy diet as well as dietary requirement for special groups of people. This topic also discusses the challenges faced by the special groups of people in complying with therapeutic diet. Hopefully by learning this topic, you will be able to plan a diet based on your personal requirement. Topic 5 discusses the concept of weight management related to body mass index (BMI). You will be able to relate obesity, anorexia nervosa and bulimia as a consequence of eating disorders. It is hoped that by the end of this topic, you will be able to suggest techniques for ideal weight management. Topic 6 highlights the importance of disease prevention to promote health and wellness. Then, there is a discussion on common non-communicable diseases that are linked to life style choices. Hopefully by going through this topic, you will be able to apply the knowledge to suggest preventive approaches for coronary heart disease, cancer, diabetes mellitus, osteoporosis and kidney disease. In addition, you will be able to design your own personal plan to improve your health and wellness based on appraisal of risk for diabetes and osteoporosis. Topic 7 focuses on financial health and wellness. This topic begins with a discussion on financial health and financial wellness, followed by the challenges confronting young adults in their quest for financial wellness. Then, you will be introduced to the elements of financial wellness. Lastly, you will learn about financial fitness. Hopefully by the end of this topic, you will be able to construct your own financial fitness plan based on the knowledge given in this topic as well as other topics.
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TEXT ARRANGEMENT GUIDE Before you go through this module, it is important that you note the text arrangement. Understanding the text arrangement will help you to organise your study of this course in a more objective and effective way. Generally, the text arrangement for each topic is as follows: Learning Outcomes: This section refers to what you should achieve after you have completely covered a topic. As you go through each topic, you should frequently refer to these learning outcomes. By doing this, you can continuously gauge your understanding of the topic. Self-Check: This component of the module is inserted at strategic locations throughout the module. It may be inserted after one sub-section or a few subsections. It usually comes in the form of a question. When you come across this component, try to reflect on what you have already learnt thus far. By attempting to answer the question, you should be able to gauge how well you have understood the sub-section(s). Most of the time, the answers to the questions can be found directly from the module itself. Activity: Like Self-Check, the Activity component is also placed at various locations or junctures throughout the module. This component may require you to solve questions, explore short case studies, or conduct an observation or research. It may even require you to evaluate a given scenario. When you come across an Activity, you should try to reflect on what you have gathered from the module and apply it to real situations. You should, at the same time, engage yourself in higher order thinking where you might be required to analyse, synthesise and evaluate instead of only having to recall and define. Summary: You will find this component at the end of each topic. This component helps you to recap the whole topic. By going through the summary, you should be able to gauge your knowledge retention level. Should you find points in the summary that you do not fully understand, it would be a good idea for you to revisit the details in the module. Key Terms: This component can be found at the end of each topic. You should go through this component to remind yourself of important terms or jargon used throughout the module. Should you find terms here that you are not able to explain, you should look for the terms in the module.
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References: The References section is where a list of relevant and useful textbooks, journals, articles, electronic contents or sources can be found. The list can appear in a few locations such as in the Course Guide (at the References section), at the end of every topic or at the back of the module. You are encouraged to read or refer to the suggested sources to obtain the additional information needed and to enhance your overall understanding of the course.
PRIOR KNOWLEDGE No prior knowledge required.
ASSESSMENT METHOD Please refer to myVLE.
REFERENCES Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and fitness (2nd ed.). Belmont, CA: Wadsworth. Edlin, G., & Golanty, E. (2010). Health and wellness (10th ed.). Sudbury, MA: Jones & Bartlett. Hoeger, W. K., & Hoeger S. S. (2003). Lifetime physical fitness and wellness: A personalized program (7th ed). Belmont, CA: Thomson Wadsworth. Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA: McGraw-Hill. Ismawati, S., Zainalabidin, M., & Golnaz, R. (2014). Healthy eating: The preventive factors among Malaysians. Journal of Economics, Business and Management, 2(4), 257-261. National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia. (2010). Malaysian dietary guidelines. Retrieved from http://dg.cnsoc.org/upload/affix/20140818104029708.pdf Payne, W. A., Hahn D. B., & Mauer, E. B. (2005). Understanding your health (8th ed). Boston, MA: McGraw-Hill.
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Pruss-Ustun, A., & Corvalan, C. (2006). Preventing disease through health environment: Towards an estimate of the environmental burden of disease. Geneva, Switzerland: WHO Press. Whitney, E. N., & Rolfes, S. R. (2002). Understanding nutrition (9th ed.). Victoria, Australia: Wadsworth Thomson Learning. Williams, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health, fitness and sport (10th ed.). New York, NY: McGraw-Hill.
TAN SRI DR ABDULLAH SANUSI (TSDAS) DIGITAL LIBRARY The TSDAS Digital Library has a wide range of print and online resources for the use of its learners. This comprehensive digital library, which is accessible through the OUM portal, provides access to more than 30 online databases comprising e-journals, e-theses, e-books and more. Examples of databases available are EBSCOhost, ProQuest, SpringerLink, Books24x7, InfoSci Books, Emerald Management Plus and Ebrary Electronic Books. As an OUM learner, you are encouraged to make full use of the resources available through this library.
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Topic
1
Concept of Health and Wellness
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Differentiate between health and wellness;
2.
Describe the characteristics of a healthy lifestyle;
3.
Identify the personal responsibilities for attaining and maintaining health and wellness in an individual;
4.
Identify factors which characterise the health and wellness state of an individual; and
5.
Summarise the benefits of a comprehensive health and wellness lifestyle.
INTRODUCTION Let us begin our learning of this module by first considering a concept which may be familiar to you.
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CONCEPT OF HEALTH AND WELLNESS
Figure 1.1: A common wish during birthdays
How do you feel when someone conveys an affectionate greeting such as illustrated in Figure 1.1 above? What type of message and feelings are expressed when we greet a person? I am sure you would agree that the message implies wishes for good health, abundance of wealth and happiness. Such greetings establish a sense of pleasantness and enhance social interactions especially on joyous occasions such as holidays, birthdays, weddings and other celebratory events. The pleasantries conveyed through greetings transcend gender, economic status, race, religion, culture, as well as age. Reflect about the times when you personally greeted someone who mattered and likewise, you must have felt good when the good wishes were returned. Expressions consciously or unconsciously represent a value we attach to being happy, healthy and prosperous for ourselves as well as those who are dear to us. Considering that, the expressed intention of greetings is mainly to convey goodness in an affectionate manner, the wishes acknowledge that a multitude of elements are important for a true sense of contentment and well-being in life. The contents of well wishes combine at least three elements ă in this case, happiness, healthiness and prosperity, to be bestowed upon its recipients. The context of a greeting conveys a wish for a delightful state of mind manifested in the form of a psychological feeling of joy, freedom from physical infirmity, and an accumulation of material wealth to signify prosperity.
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CONCEPT OF HEALTH AND WELLNESS
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An important inference one can draw from the foregoing discussion is that the well-being of a person is dependent on a combination of factors. Hence, happiness, healthiness and prosperity are collectively desirable elements for a sense of well-being. It is difficult to be happy if one is not healthy. Likewise, one may not be able to relish his/her prosperity if one is not happy or healthy enough to enjoy it. In the following subtopics, you will acquire further clarity on the concepts of health and wellness as being vital components of well-being. In addition, the contents of the subtopic will also cover characteristics of a healthy lifestyle, personal responsibilities for attaining and maintaining health and wellness, factors that characterise the health and wellness state of an individual and the benefits of a comprehensive health and wellness lifestyle. We hope that you will enjoy this first topic and gain a lot of knowledge on health and wellness. Let us delve deeper into the lesson!
1.1
MEANING OF HEALTH
Let us first look at the meaning of health. Later in the next subtopic, we will look at the concept of wellness. Hopefully, by the end of these two subtopics, you will be able to differentiate between health and wellness. How would you define health? As you may be well aware, there are people who may not have an actual idea about what „health‰ means, though each may express it in his/her own unique way. Some however understand what „health‰ means but are unable to express the concept clearly. Let us look at a formal definition of health by the World Health Organization (WHO). „Health‰ can be defined as the state of complete physical health, mental health and social well-being, and not merely the absence of illness and infirmity. WHO (2003)
As you can infer from the definition by WHO, being healthy encompasses a wide span of factors and is not just about being free from diseases. Since the established definition by WHO, there have been additional explanations to help further clarify health as a concept within several dimensions. Currently, many people describe health as being a multidimensional concept encompassing different aspects of personal life. For example, Donatelle, Snow and Wilcox (1999) consider the concept of health as Copyright © Open University Malaysia (OUM)
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being a vigorous balance between the social, physical, psychological, intellectual, environmental and spiritual dimensions of a person. Today, health is regarded as a dynamic and ever-changing concept that is very much dependant on personal choices. This implies that a person can influence his or her health either positively or negatively, through life-style preferences. Conversely, there are people today who experience an on-going struggle between choosing to indulge in negative habits or maintaining a healthy lifestyle. These components of health will be described further in the subsequent subtopics.
ACTIVITY 1.1
1.
2.
1.2
Based on the definition of „health‰ by WHO (2003), identify the status of each of the following characteristics of health in your own personal life: (a)
Physical health;
(b)
Mental health; and
(c)
Social well-being.
Cite any major differences between the WHO definition and other explanations of health.
MEANING OF WELLNESS
Now let us continue our lesson by focusing on wellness. Over the years, new discoveries and technological innovations have improved literacy and understanding of the significant value of preventive and promotive aspects of healthcare preservation. Consequently, expectations are growing from merely being healthy to aspirations for a higher quality of life. People no longer accept that being healthy and disease-free means subscribing to a „pill-popping‰ culture. Rather, they wish to be stronger and fitter and strive in sports and recreational physical activities to be reassured of their superior wellness state.
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CONCEPT OF HEALTH AND WELLNESS
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Historically, the concept of „wellness‰ was first introduced in the early 1970s to represent individual attempts at perking up the existing state of health. Dunn (1977) first used the word „wellnessÊ to signify an active process in which a person becomes aware of and makes conscious personal choices to achieve a healthier state of being in all important dimensions of his or her life. Edlin and Golanty (2010) further summed up the concept of wellness as being a proactive and preventive approach designed to achieve optimum levels of physical health, as well as social and emotional functioning. It can be seen as a commitment within personal limitations and potentials and a process of continued striving towards optimal health, without merely focusing on the absence of diseases. From the previous explanations, it is hoped that you have noticed the subtle differences between „wellness‰ and „health‰. To summarise, health is a state of well-being at a particular moment based on the ability of an individual to perform basic activities of daily living. Wellness on the other hand, is an active process through which a person becomes aware of personal limitations and makes conscious choices to gain more independence from the constraints to his or her contentment for a successful existence. Are you ready for the next subtopic? We will explore the significant characteristics that reflect a health and wellness lifestyle in the following subtopic.
SELF-CHECK 1.1 Differentiate between health and wellness.
ACTIVITY 1.2 Reflect on your own state of health and answer the following questions: (a)
What are some of your concerns regarding personal health issues?
(b)
Write down some examples of activities you may wish to do to improve your personal wellness.
(c)
Compare your answers to the above questions with those of your course mates.
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1.3
TOPIC 1
CONCEPT OF HEALTH AND WELLNESS
CHARACTERISTICS OF A HEALTHY LIFESTYLE
After reading this subtopic, I hope that you will be able to describe the characteristics of a healthy lifestyle. Now that you have a basic understanding about the concepts of health and wellness, let us deliberate on the characteristics of a healthy individual. Before we proceed, do ponder about the kind of life you live now and what improvements you wish for yourself in the future. Chances are that you will opt for being well, having an abundance of energy for your daily activities and being free to pursue your dreams for as long as GodÊs given lifespan permits. Why do we need to choose a healthy lifestyle? A healthy lifestyle offers a choice of living behaviours which maximise the state of wellness and decrease risk of illness and premature death. Choices for leading a healthy lifestyle can be influenced by a multitude of personal factors as well as external influences. Examples of personal factors range from internal to external motivation, personal values, ethics and cultural influences, religious beliefs and fear of life-threatening diseases. On the other hand, external influences that affect lifestyle choices include environmental, political and socioeconomic factors. The characteristics of a healthy lifestyle will be determined by the effects of the choices a person makes in response to personal habits and the external influences that will shape his or her health status. What can a person do to adopt a healthy lifestyle? The immediate choice may be driven by the degree of internal or external locus of control within the person for the desire to change. A person with strong internal locus of control will be inspired by a personal wish to adopt a healthy lifestyle, regardless of how strong the obstacles are. A person with a strong sense of external locus of control, on the other hand, would want to survey the worth of external rewards or approval from external sources as a reason to commit to change. Sometimes the external source of persuasion to act may seem trivial or intangible such as idealistic thinking of wellness after seeing a model that we admire or a chance reading of an article on health and wellness strategies. At other times, the desire could be more resolute such as making a strong commitment to change dietary practices after a disheartening observation of body weight on the weighing scale. Whatever the motives, closing the gap between aspiration and accomplishment requires a firm commitment that is executed gradually in a consistent manner towards desired goals. Copyright © Open University Malaysia (OUM)
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CONCEPT OF HEALTH AND WELLNESS
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Humans are very much influenced by social factors. Many of our motives and compulsions are driven by external influences. We all wish to look and feel good especially within our social circles. It is a common human trait to be acutely conscious about body image. But a person who has invested time and effort to maintain a high degree of wellness will project self-confidence and will not easily be distraught by the negative opinions of others. The nature of relationship a person forges with other people as well as appreciation and tolerance for diversity are also important factors for enhancing the state of wellness. Light hearted humour and open-mindedness help to block out negativity and promote positive thoughts in an individual. These wellness behaviours contribute to the development of a positive awareness which can reduce stress and have significant influence on the health and wellness of a person. Based on the above discussion, we can see that lifestyle choices can be influenced by numerous circumstances, ranging from personal factors to external influences. Whatever the nature of influence, ultimately, it is up to the individual to act. The following are some guidelines that characterise healthy lifestyle choices: (a)
Eating a well-balanced and nourishing diet;
(b)
Maintaining a healthy body weight;
(c)
Regular exercising;
(d)
Able to control stress;
(e)
Able to manage extreme emotions;
(f)
Adequate rest and sleep;
(g)
Maintaining a healthy balance between work and social activities;
(h)
Engaging in spiritual nourishment or worship according to oneÊs faith;
(i)
Avoidance of smoking, alcohol and abuse of recreational drugs;
(j)
Regular health screening for early detection of health threats;
(k)
Prioritising personal safety;
(l)
Making an effort for continuous self-improvement;
(m) Maintaining an optimistic and positive outlook at life; and (n)
Being an active advocate for a healthy environment.
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ACTIVITY 1.3 Reflect on your current state of health and work on the following: (a)
List down as many factors as possible that have influenced your current health status.
(b)
Draw up a personal „wish-list‰ that would significantly improve your current state of health.
1.3.1
Personal Responsibility for Health and Wellness
Let us continue our lesson. It is hoped that by going through this subtopic, you will be able to identify the personal responsibilities for attaining and maintaining health and wellness in an individual. A utilitarian perspective of health and wellness will subscribe to the assumption that people should take personal responsibility to enhance their quality of life. Alternatively, giving in to adverse sentiments such as negative thoughts, procrastination and feelings of „self-pity‰ will only depreciate the state of wellness. In the next subtopic, we will examine some of the attributes which impact an individualÊs personal responsibility for health and wellness. What are they? Let us look at Figure 1.2 for the answers.
Figure 1.2: Three attributes of personal responsibilities for attaining and maintaining health and wellness in an individual
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CONCEPT OF HEALTH AND WELLNESS
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Now let us look at these three attributes further. (a)
Personal Responsibility for Action Individuals who strive to maintain optimum health are often able to differentiate between modifiable risk factors and non-modifiable risk factors that have an influence over their health status. What do these factors refer to? Let us look at Table 1.1 for the answers. Table 1.1: Modifiable Risk Factors versus Non-modifiable Risk Factors Modifiable Risk Factors
Non-modifiable Risk Factors
Refers to factors within the control of an individual, whereby he or she can take action to reduce or prevent the risks of adverse events from occurring, such as choosing to refrain from smoking.
Refers to factors that are not within the control of an individual, such as increased vulnerability to certain diseases due to gender or as a result of advancing age.
Realisation of modifiable and non-modifiable risk factors will help people to adjust their physical activities to suit their personal capabilities and limitations when making conscious choices to improve their wellness state. With the right information, they can make strong personal commitments to modify their lifestyles and avert negative behaviours that will impede their quest for optimal health. There are several guidelines to enhance modifiable behavioural patterns such as: (i)
Engaging in regular and effective physical exercises;
(ii)
Not smoking or indulging in recreational drugs or alcohol;
(iii) Eating wholesome nutritious meals; (iv) Striking a healthy balance between work, personal, family and social life; (v)
Shunning excessive stressors; and
(vi) Advocacy for health-orientated policies and programmes within the family and community.
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(b)
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CONCEPT OF HEALTH AND WELLNESS
Concern for Others Societal elements have a strong potential to influence the health and wellness choices of a person. People-centred individuals tend to enjoy a greater sense of wellness compared to social recluses. The former readily exude an aura of social connectedness and possess a tendency to be more comfortable in adapting to changing situations while remaining committed to their wellness goals. This group of people also seem to be good role models for others who may wish to participate in wellness orientated activities but are shy to do so. Good individuals show a caring attitude through words and actions that reflect their respect and concern for others around them. In addition, they tend to be un-critical and do not impose their own values by being judgmental towards others. They are more likely to be socially aware of variants in health issues among other people around them and act in a socially responsible manner to fit in with like-minded individuals with similar goals.
(c)
Health Awareness and Sound Decision-making Although it is said that psychology has influence over physiology, achieving a high degree of wellness does not happen overnight by just wishing or being positive about it. Some people who are in a hurry to get fit, look for „shortcuts‰ through the means of commercial „fast-track‰ formulas that are being peddled in the market. Disillusionment however sets in after awhile once the promised hype fades and they realise the truth about the „no pain, no gain‰ maxim to reap benefits from exercise and physical fitness. An individual who manages to sustain a wellness state over a period of time is a person who consciously chooses to set aside dedicated time and energy for wellness enabling activities that are well within his or her means of achieving. The difference between failure and success in sustaining a wellness programme especially for the long haul is in the sound awareness of personal capabilities and limitations. Informed choices based on facts to support decision-making processes help to sustain interest and endurance in fitness activities over a longer period.
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CONCEPT OF HEALTH AND WELLNESS
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The success of any programme let alone a fitness plan is to design a personalised course that fits individual needs and takes into account his or her current state of health and fitness level. For the successful execution of an effective wellness programme, a person needs to have a compelling desire to change or adapt their present lifestyle for a more healthy option that is well-planned to suit the individual. For beginners, a good preparatory step is to get a proper medical check-up and sort out any other issues so that their chosen programme would be of the right intensity and physiologically beneficial. Usually health and wellness experts are able to advise beginners on the right plan based on available resources as well as their current state of health. Last but not least, individuals should gather appropriate information by reading wellness literature and through consultation with a health and wellness practitioner in order to make informed decisions for a personalised fitness programme. These tips will help you to decide on the appropriate exercise routines and related rehabilitation methods, dietary modifications, current state of health and targets to achieve short-term and long-term wellness.
ACTIVITY 1.4 1.
List five examples each of modifiable and non-modifiable risk factors that can influence wellness in a person.
2.
Identify two examples of negative thoughts. Discuss how they can impact the general wellness of a person.
3.
Discuss with two examples how self-centred behaviour and a judgmental attitude can impact the general well-being of a person.
4.
Recommend general strategies that would encourage more teenagers to participate in health and wellness activities.
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1.4
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CONCEPT OF HEALTH AND WELLNESS
INFLUENCES ON HEALTH AND WELLNESS
Now we come to a new subtopic that looks at influences on health and wellness. Hopefully, upon completion of this subtopic, you will be able to recognise the factors that characterise the health and wellness state of an individual. Clearly, there are numerous factors that influence people to pursue fitness and adopt a healthy lifestyle. Most people who are consistent in their efforts to maintain their health do so with the firm belief of reaping a range of physical, psychological and social benefits for themselves. Then, there are fitness buffs who take up fitness activities after being inspired by good-looking role models. There are still others who indulge in fitness activities solely to develop their physique to draw attention to themselves. Keep in mind that a realistic awareness of motives is necessary to maintain a rational balance between the expectations of benefits from partaking in sports and fitness activities and the risks associated to personal well-being. Besides, participating in a wellness programme does not necessarily shield a person from the risk of illness nor bestow permanent immunity from all major ailments. It is just that the likelihood of developing an illness is far less than those who neglect healthy lifestyle activities all together. In the following subtopic, we will consider specific factors that cause people to be susceptible to diseases, regardless of their state of fitness.
1.4.1
Predisposing Factors
What do predisposing factors mean? Predisposing factors are characteristics in a person that motivate behaviour towards certain habits or acts.
There are over seven billion people on this planet today. Although we are all unique in our own ways, we are also similar in others. All humans have similar physiological needs yet there are some socio-cultural and individual uniqueness among us.
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There is a popular saying that we are a product of our past. Our unique traits are in many ways influenced by genetic factors passed down from our ancestors. Blood-linked family members are particularly vulnerable to certain diseases that are genetically inherited. Often close family members with these chronic diseases pass down their genetic predisposition to their offsprings. Genetic traits can carry risks of serious chronic diseases such as diabetes, hypertension, mental disorders and serious blood disorders like haemophilia and thalassemia. The good news is that even though a person may have genetic predisposition towards certain types of chronic diseases, following properly designed and comprehensive health and wellness programmes can reduce the risks or delay the onset of such conditions. Although you may not be able to avoid your genetic predisposition for certain diseases, you can still make lifestyle changes to reduce the chances of developing them. For example, if a person has a family history of diabetes, it would be wise for him or her to start early in life to adopt suitable lifestyle changes as a preventive strategy to reduce the risk of developing diabetes later on. Aside from genetic factors, the general nature of emotional responses of a person in dealing with his or her daily life also has a significant influence on health and wellness outcomes. Usually, a healthy person who is emotionally resilient would be more able to rebound back easily from incidents of emotional trauma. Apart from these dispositions, social and environmental conditions are also significant predisposing factors that influence health and wellness. The nature and quality of interpersonal relationships can influence a person to be positiveminded, loving and well-adjusted. But on the flip side, it can result in a person indulging in unhealthy and risky activities such as violence, heterosexual practices, smoking and alcohol and drug abuse. Conforming to herd-mentality and peer pressure are some examples of social influences that shape a personÊs action. It is believed that children of alcoholic parents have a greater risk of becoming alcoholic themselves, but if their social environment is altered to become more healthy and positive, the risks can be easily neutralised. Another predisposing factor that greatly influences health and wellness choices are values, attitudes and beliefs that are instilled in a person from early childhood. Children of health conscious parents are more likely to choose healthy activities as their natural recreational pursuits. Alternatively, children brought up in a family of obese siblings while practising poor dietary habits and sedentary lifestyles, will be more likely to perpetuate such poor practices as adults.
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ACTIVITY 1.5 Identify the obstacles that you may be facing yourself in pursuing a regular health and wellness plan in your life.
1.4.2
Reinforcing Factors
Now we will examine the role of reinforcing factors that influence health and wellness. Do you have any idea what they are? Reinforcing factors for health and wellness are elements that help to promote and encourage behaviours towards health and wellness options in a personÊs life. They are regarded as the reverse of predisposing factors as these attributes provide added impetus to enhance the chances for certain traits to occur readily. Usually, encouragement to persevere with a health and wellness programme is greatly influenced by reinforcing factors. For example, displaying gory pictures of cancer victims on cigarette packets will help to reinforce abstinence from smoking. Some reinforcing factors may be due to external or internal motives as they may be linked to a variety of personal reasons for persisting with a wellness programme. Examples of external drivers may range from wanting to look and feel good in the eyes of peers or loved ones, to conforming to a particular social group that espouses the importance of health and wellness. Similarly, people with an internal sense of reward are driven by a personal commitment to maintain their wellness. For example, let us look at marathon runners (see Figure 1.3). What motivates them to pursue their sport?
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Figure 1.3: Marathon runners report a sense of „runnerÊs high‰ caused by the release of endorphins in their bodies after a long distance run ă this motivates them to complete their run
ACTIVITY 1.6 Identify at least five potential benefits that could motivate an adult to adopt a regular health and wellness programme.
1.4.3
Barriers to Wellness
Do you agree that sometimes it is very difficult to make lasting changes to habits and behaviours? Why is it that some people are successful in maintaining an exercise programme for long periods of time while others tend to give up after a short try? How about you? Which category do you fall into? There are many tangible as well as barriers that prevent the adoption of healthy lifestyle behaviours. For example, economic factors can be a major obstacle for a person even if he or she is very passionate about leading a health and wellness lifestyle. A person with an average income would find it challenging to spend money regularly on a costly fitness programme or having to purchase customary exercise apparel. For some people, health and wellness activities are regarded as secondary choices compared to physiological and security needs. In addition, the nature of occupation and work schedules also influence the continuity of a health and wellness routine. Many people who work on rotating shifts find it hard to cope with a regular exercise programme, particularly due to disruption of their circadian rhythm.
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Furthermore, urban settings have been identified as another major factor that impacts participation in health and wellness routines. Overcrowding, pollution and lack of safety measures are major features of many urban settings, which then discourage fitness activities. Playgrounds and recreational parks are scarce due to the ever increasing premium on land space. The emergence of commercial gymnasiums and fitness clubs does provide a conducive ambience for fitness, but often these exclusive establishments are commercial in nature and cater mostly for the well-to-do.
ACTIVITY 1.7 Discuss strategies that a shift worker could adopt in order to pursue a regular health and wellness programme.
1.4.4
Lifestyle Influences
So far, we have considered several factors that can influence positive behavioural changes for health and wellness initiatives. In this subtopic, let us examine the effects of personal lifestyle choices which motivate action or delay participation in improving oneÊs overall health and wellness state. Generally, the choices that people make have a significant impact on the quality and length of their lives. For example, decisions to indulge in risky forms of behaviours can lead to detrimental consequences even in the pursuit of health and wellness activities. Inappropriate selection of physical activities and extreme forms of recreational indulgence increase the chances of adverse reactions and freak accidents. Other risks or undesirable consequences in sports include doping to enhance performance or for recreation, smoking and alcoholism. In addition, a sudden change in fitness levels of people who shift from a sedentary lifestyle to pursue physically challenging activities, obesity, indulging in high risk sexual activities without safety precautions, excessive hostility in competition, uncontrolled aggression and poor adaptation to stress can also increase the risk of dangerous incidents. There are some people with delusional thinking who believe that they are immune to negative health effects as a result of their risky behaviours. Unfortunately, most of the time these are the people who are likely to „drop dead‰ one day.
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ACTIVITY 1.8 1.
Discuss the detrimental effects of smoking on the health and wellness of a person.
2.
Do you agree with the expression that „health is wealth‰? Discuss your opinion with other learners.
1.5
BENEFITS OF A COMPREHENSIVE HEALTH AND WELLNESS LIFESTYLE
What are the benefits of a comprehensive health and wellness lifestyle? What can you gain from this lifestyle? Each dimension of a wellness activity contributes to a set of bodily changes for overall health benefits of a person. Many of the positive lifestyle choices a person makes today will yield short-term health benefits as well as contribute to the overall well-being of the individual and society. For example, physical fitness due to regular exercise and proper dietary practices will lead to improved cardiovascular fitness and enable a person to be involved in team sports with friends. In fact, this will improve goodwill and cordiality within their social circles and help reduce stress and increase self-esteem among group members. If you make it a routine, this cycle will lead to higher levels of personal physical conditioning along with improvements in cardiovascular fitness as well as boost energy levels. Your actions will also help to perpetuate a healthy culture among your friends and family. Such efforts will lead on towards creating a healthy and happy community. There is an extensive list of benefits that one can gain by maintaining a high degree of wellness. Some of these benefits are listed in Figure 1.4.
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Figure 1.4: Six benefits of a comprehensive health and wellness lifestyle
These six benefits are explained further in the following subtopics.
1.5.1
Improved Cardiovascular or Heart and Blood Vessels Efficiency
Can you explain the functions of the heart? The principle function of the heart is to pump blood through the circulatory system to enable oxygen to reach the body cells and remove waste matter from the cells. Therefore, an improved cardiovascular system will maintain this function effortlessly throughout the lifetime of a person and enable the individual to function with minimal strain.
1.5.2
Increased Muscle Tone, Strength, Flexibility and Endurance
What can good muscle tone provide? Good muscle tone provides shape for the body as well as the ability for limbs to move and act to fulfil daily activities. Therefore, increased muscle strength supports economic activities that can improve the quality of life for an individual. A physically fit person invariably makes good choices in life, as well as enjoys flexibility and endurance against stress and fatigue. A well-developed musculoskeletal system also protects the body against injuries from strains and sprains. Bones and joints support the bodyÊs movements, provide agility and strength and protect the body from injury.
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1.5.3
CONCEPT OF HEALTH AND WELLNESS
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Improved Self-control, Self-efficacy and Self-esteem
People who have better control over their health seem to exude a higher sense of self-esteem and feel good about themselves, just like in Figure 1.5.
Figure 1.5: A person with high self-esteem always feels good about himself or herself
Such feelings of goodness and self-confidence can positively impact other areas of a personÊs life as well as people around him or her.
1.5.4
Improved Stress Management and Outlook in Life
A healthy person is more likely to have a positive outlook at life and be able to control stress and change perceptions that lead to an unnecessary build-up of stress. In addition, the person also has the potential to recover quickly from a stressful event and is able to think clearly about options to withstand pressure. People with self-confidence are generally better equipped to face challenges and setbacks and see them as opportunities and growth experiences.
1.5.5
Improved Interpersonal Relationships
Did you know that successful interpersonal relationships often require complex social dynamics? This includes an assortment of physical and psychological wellbeing being present in an individual. An internal „feel good‰ factor is an essential ingredient for a person striving to maximise his or her social appeal. Copyright © Open University Malaysia (OUM)
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1.5.6
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Decreased Mortality and Morbidity from Illnesses
Did you know that high levels of physical fitness support a well-functioning immune system? Our immune systems can protect our body from infectious diseases. In fact, reduced stress levels and proper rest, good dietary habits and exercises improve cardiovascular fitness and optimal body functioning, which can delay the onset of chronic diseases. All these forms of protection help to protect the body against premature death and promote chances of rapid, full recovery from ailments.
SELF-CHECK 1.2 Describe the benefits of a comprehensive health and wellness lifestyle.
1.6
CONCLUSION
Congratulations! You have successfully completed the first topic. It is hoped that you have grasped the basic concepts for an individual to take personal responsibility for his or her health and wellness. The next topic will further expand on the concepts of wellness and provide you with a holistic view of the eight dimensions of wellness namely; emotional, environmental, financial, intellectual, occupational, physical, social and spiritual dimensions. It is hoped that the understanding gained from reading this module will enrich you intellectually and at the same time, empower you on a path of personal wellness. All the best!
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ACTIVITY 1.9 1.
Complete this personal health history questionnaire: Personal Health History 1.
Have any primary relatives (father, mother, siblings) suffered coronary or other atherosclerotic disease prior to age 55? Yes ă 1
2.
No ă 3
Do not know ă 2
No ă 3
Do not know ă 2
No ă 3
Do not know ă 2
No ă 1
Not regular ă 2
No ă 3
Do not know ă 2
Do you smoke cigarettes? Yes ă 1
12.
Do not know ă 2
Are you obese (> 20lbs or 9kg over average body weight)? Yes ă 1
11.
No ă 3
Do you have medical health exams once a year? Yes ă 3
10.
Do not know ă 2
Is your blood pressure 140/90mmHg? Yes ă 1
9.
No ă 3
Is your total cholesterol 20mg/dl? Yes ă 1
8.
Do not know ă 2
Do any of your primary relatives have high cholesterol? Yes ă 1
7.
No ă 3
Do any of your primary relatives have high blood pressure? Yes ă 1
6.
Do not know ă 2
Have any of your primary relatives had cancer? Yes ă 1
5.
No ă 3
Do any of your primary relatives have osteoporosis? Yes ă 1
4.
Do not know ă 2
Do any of your primary relatives have diabetes? Yes ă 1
3.
No ă 3
No ă 3
Not everyday ă 2
Would you rate yourself as a physically inactive person? Yes ă 1
No ă 3
Not sure ă 2
Scoring to assess risk for developing chronic diseases: 20 High risk 21 ă 29 Moderate risk 30 Low risk Source: Adapted from Donatelle, Snow & Wilcox (1999) Copyright © Open University Malaysia (OUM)
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2.
Based on your score levels, prepare an action plan for healthy lifestyle activities for yourself. Present your plan in class and compare your plan with others to identify similarities and differences in approaches to activities and priorities for wellness.
3.
It is said that investing in 20 to 30 minutes of regular exercises per week can prospectively hinder 20 or more years of being bed-ridden during old age. Referring to the preceding statement give some examples from your own life experiences to support or negate it.
Based on the definition by WHO (2003), health is a state of complete physical health, mental health and social well-being; not merely the absence of illness and infirmity. Health can also be understood as a state of well-being as a result of vigorous balance between the emotional, environmental, financial, intellectual, occupational, physical, social and spiritual dimensions of a person.
Wellness is an active process through which a person becomes aware of personal limitations to health and makes conscious choices to gain more independence from the constraints to his or her contentment to enjoy a happy and successful existence.
Some characteristics of a healthy lifestyle for an individual include eating a well-balanced and nourishing diet, maintaining a healthy body weight, regular exercises, being able to control stress, having adequate rest and sleep, maintaining a healthy balance between work and social activities, being able to manage extreme emotions, being an active advocate for a healthy environment and others.
Personal responsibilities for attaining and maintaining health and wellness in an individual include assuming personal accountability for actions to restore health, showing concern for the health and welfare of others and reliance on evidence for sound decision making on health matters.
The quality of health and well-being of an individual are influenced by predisposing factors, reinforcing factors and barriers to wellness.
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Some of the benefits of a comprehensive health and wellness lifestyle include improved cardiovascular or heart and blood vessels efficiency, increased muscle tone, strength, flexibility and endurance, decreased mortality and morbidity from illnesses and others.
Awareness
Personal responsibilities
Barriers to wellness
Predisposing factors
Body image
Regular exercises
Cardiovascular or heart and blood vessels efficiency
Reinforcing factors
Conscious personal choices Health Healthy lifestyle Ideal body weight Interpersonal relationship Mortality and morbidity Muscle tone
Self-control Self-efficacy Self-esteem Sound decision-making Strength, flexibility and endurance Stress management and outlook Well balanced and nourishing diet Wellness
Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and fitness (2nd ed.). Belmont, CA: Wadsworth. Dunn, L. (1977). What high level wellness means. Health Values, 1(1), 9. Edlin, G., & Golanty, E. (2010). Health & wellness (10th ed.). Sudbury, MA: Jones & Bartlett. World Health Organization. (2003). WHO definition of health. Retrieved from http://www.who.int/about/definition/en/print.html
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2
Dimensions of Health and Wellness I
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Identify eight dimensions of health and wellness;
2.
Plan physical activities that will contribute to physical wellness;
3.
Select the strategies to achieve balanced emotional wellness;
4.
Employ the spiritual support to enhance wellness; and
5.
Evaluate the significance of intellectual dimension in wellness.
INTRODUCTION Let us start this topic by reading the following quote from Benjamin Disraeli (refer to Figure 2.1):
Figure 2.1: Benjamin Disraeli, former prime minister of Great Britain (from 1804 to 1881) Source: www.azquotes.com Copyright © Open University Malaysia (OUM)
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What can you infer from this quote? Obviously, the quote in Figure 2.1 states the importance of health. But do you know that there are other dimensions as well that are essential to health and wellness? These are the physical, emotional, spiritual and intellectual dimensions which are important attributes for health and wellness. Therefore, this topic will focus on these four dimensions ă physical, emotional, spiritual and intellectual. Are you ready to discover more? Let us start the journey!
2.1
DIMENSIONS OF HEALTH AND WELLNESS
Let us start off by learning the eight dimensions of wellness. Hopefully by the end of this lesson, you will be able to identify them. Do you agree that health is more than a matter of individual choices, family and other social relationships? For instance, if a spouse has a serious illness, the chances that his/her marital partner will acquire a serious illness doubles (Stroebe et. al, 2007). This is the reason why the philosophy of holistic health emphasises the unity of the mind, spirit and body. Therefore, symptoms of illness and disease may be viewed as an imbalance in a personÊs total state of being and is not simply as the malfunction of a particular part of the body. For example, think of the time when you had a headache. Although headaches can be associated with brain injury or the symptoms of another illness, more often than not it is caused by emotional stress. This produces a tightening of the muscles on the neck or head. These contracting muscles increase the blood pressure in the head, thereby causing the headache. Most people relieve headaches by taking analgesic drugs or seeking other alternative remedies such as massage to relieve the pain as it can alter physiological mechanisms that produce the pain. In contrast, someone may use the holistic approach as the first step to determine the source of stress, tension, worry, anger or frustration and then plan to reduce the emotional stress that may cause the illness.
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Health can also be defined as a reflection of your ability to use the intrinsic and extrinsic resources related to each dimension of health to participate fully in the activities that contribute to your growth and development, with the goal of feeling a sense of well-being as you evaluate your progress through life (Payne, Hahn & Mauer, 2005). Did you realise that the real problem of health lies within ourselves? Even though most people are aware of their unhealthy lifestyles such as smoking, inactivity, high-fat diets or excessive stress, they seem satisfied as long as they think they are free from any symptoms of diseases or illness. Therefore, they will not change their lifestyle until they suffer a major health problem such as hypertension, diabetes or heart problems. That is why it is important for us to recognise that our current lifestyle habits dictate our future health and wellbeing. There are eight dimensions to wellness, namely, physical, emotional, spiritual, intellectual, social, occupational, environmental and financial (refer to Figure 2.2). However, for this subtopic, we will discuss the first four dimension which are; physical, emotional, spiritual and intellectual.
Figure 2.2: Eight dimensions of wellness Copyright © Open University Malaysia (OUM)
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The description of the four dimensions that we will look into in the next subtopic is as follows: (a)
Physical Dimension There are many factors that contribute to the physical well-being of a person or individual including physical fitness, regular exercise and well balanced diet.
(b)
Emotional Wellness We can apply some strategies to achieve this by remaining flexible and compromising in order to solve problems.
(c)
Spiritual Wellness Did you realise that in order to cope with stress, another significant dimension is the spiritual aspect? It is the ability of a person to integrate their beliefs and values into their actions.
(d)
Intellectual Dimension What can we say about this? This dimension is the ability of a person to contribute ideas, think critically and seek out new challenges.
Take note that when all the dimensions to health and wellness are integrated and function together, one will achieve a high level of wellness or optimal health. Now, how do we achieve positive wellness? Well, in order to achieve positive wellness, a person must be free from symptoms of disease such as pain, being active, in good spirits and feeling emotionally healthy. In addition, the personÊs environment (including work, school, family and community) and his or her physical, emotional, intellectual, occupational, spiritual and social dimensions of wellness must also be in tune with one another in order to produce harmony. As stated before, these dimensions are interrelated; one frequently affects the others. For example, a person who is emotionally down often has no desire to exercise, study, socialise with friends, or attend mosque or church and may be more susceptible to illness. Therefore, these eight dimensions of wellness will show you how the concept clearly goes beyond the absence of disease.
SELF-CHECK 2.1 State the eight dimensions of wellness.
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2.2
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PHYSICAL DIMENSION
This subtopic introduces some physical activities that can contribute to physical wellness. Hopefully by the end of this subtopic, you can plan your own physical activities in order to stay fit and healthy. Let us learn more on the first dimension of wellness which is physical. What does it mean to be a physically well individual? Physically well individuals are those who are physically active, exercise regularly, eat a wellbalanced diet, maintain the recommended body weight and minimise exposure to environmental contaminants.
In addition, people in good physical condition also avoid harmful drugs and smoking as well as seek medical care as needed and participate in activities that help prevent illness. Naturally, good/ideal physical fitness is characterised by good cardiorespiratory endurance, enhanced adequate muscle strength, flexibility and proper body composition. Therefore, the physically fit person will be able to carry out the ordinary and challenging demands of daily life safely and effectively. How does one achieve such a condition? We will look briefly at one big factor that contributes to the physical wellness of a person, which is physical fitness.
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Nowadays, most people recognise that participating in fitness programmes would improve their quality of life. On the other hand, we must remember that improving physical fitness alone is not sufficient to lower the risk for disease and ensure better health. Let us study the following scenario: Jim Fixx (refer to Figure 2.3) is the famous author of the best seller book entitled The Complete Book of Running. He died at the age of 52 due to heart attack, although he had been running between 60 and 80 miles a week.
Figure 2.3: Jim Fixx (from 1932 to 1984) Source: www.allouteffort.com
He believed that his high level of fitness would prevent dying from heart attack. At age of 36, Jim Fixx smoked two packs of cigarettes per day, and did not participate in regular physical activity and had a family history of heart disease. His father had his first heart attack at the age of 35 and died when he was 43 years old. Jim Fixx began to raise his level of fitness. He started to jog and quit smoking. On several occasions, he declined to have electrocardiogram (ECG) test, which would likely have revealed his cardiovascular status.
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Now, what can you say as a conclusion to the given scenario? It illustrates that an exercise programme itself is unable to make high-risk people immune to heart disease, though it may delay the onset of cardiac arrest. What kind of exercises can you practise to achieve physical fitness? Well, let us look at Figure 2.4 for some examples.
Figure 2.4: Examples of physical fitness exercise Source: http://www.fitnesshealtytips.com
Therefore, it can be said that physical wellness requires implementing positive programmes in order to change behaviours to improve health and quality of life.
2.2.1
What is Physical Fitness?
How can we define physical fitness? „Physical fitness is defined as the ability to meet the ordinary as well as the unusual demands of daily life safely and effectively without being overly fatigued and still have energy left for leisure and recreational activities.‰ (Hoeger & Hoeger, 2003)
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Did you realise that when you choose to commit to physical activities as a way of life, you will regularly exercise in order to keep fit? Aside from that, when you are pursuing your physical fitness activities, you will probably meet other healthy and active people. Through this, you will be able to expand your circle of friends.
2.2.2
Developing a Cardiorespiratory Fitness Programme
Did you know that for people of all ages, cardiorespiratory conditioning can be achieved through many activities? This is true as long as the activities you choose place sufficient demands on the heart and lungs which will improve physical fitness. The familiar activities such as swimming, running, cycling, aerobic, brisk walking, skating and even some weight training will produce cardiorespiratory fitness. Regardless of age or physical limitation, you can select from a variety of enjoyable activities to improve your cardiorespiratory system. Let us look at the recommendation for achieving cardiorespiratory fitness from The American College of Sport Medicine (ACSM). ACSMÊs (2000) most recent recommendation is to include four major areas (refer to Figure 2.5).
Figure 2.5: Four areas to achieve cardiorespiratory fitness as recommended by the American College of Sport Medicine
These four areas are further described as follows: (a)
Mode of Activity The ACSM recommends the mode of activity to be any continuous physical activity that uses large muscle groups, and can be rhythmic and aerobic in nature. Can you name some of these activities? Well, among the activities are continuous swimming, cycling, aerobic, basketball, walking and running. Just take note that regardless of which continuous activity you select, it should be enjoyable. You should also vary your activity to prevent boredom. Copyright © Open University Malaysia (OUM)
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(b)
Frequency of Training What does frequency of training refer to? Frequency of training refers to the number of times per week a person should go for exercise. So how many times are appropriate? Is it a few hours per day or per week? ACSM recommends exercising three to four times per week.
(c)
Intensity of Training How much effort should you put into an activity? Which one would you prefer; a quick run, a slow jog or a swim at a comfortable pace? Must a person sweat profusely to become fit? The intensity is the number of exercise sessions per week; for aerobic fitness 50% to 85% of your heart rate range is recommended. The level of intensity is called target heart rate (THR).
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ACSM also recommends that healthy adults exercise at an intensity level between 65% and 90% of their maximum heart rate. You should be aware that there should be considerable difference between your estimated maximal heart rate and your actual maximal heart rate. For example, a younger person, for example, a 20-year-old person with a resting heart rate of 60 beats/min, would need to participate in a continuous activity for an extended period while working at a THR of 158 beats/minute. Whereas an older person, for example, a 40-year-old person with a resting heart rate of 80 beats/min, would need to function at a THR of 150 beats per minute to achieve positive training effect. (d)
Duration of Training ACSM recommends that the duration of training should be between 20 and 60 minutes of continuous activity. Those who choose activities with low range of intensity of 50% to 60% of heart rate range should maintain the activity for longer period of time. Thus, a fast jog and a moderate walk will require different amounts of time to accomplish the training effect.
As a conclusion, we can say that a person with physical wellness is able to: (a)
Exercise regularly and select a well-balanced diet;
(b)
Make informed choices about medicine used and medical care; and
(c)
Maintain a positive health-promoting lifestyle.
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ACTIVITY 2.1 Select an exercise programme by Leslie Sanson entitled Three Fast Miles via YouTube at http://goo.gl/24avKi. Appoint an instructor and start the exercise for the first 15 minutes. Then discuss the effect of the exercise in the group.
SELF-CHECK 2.1 1.
Fitness is composed of four components ă cardiorespiratory endurance, muscular fitness, flexibility and body composition. Discuss in depth the component of cardiorespiratory endurance in physical fitness.
2.
Discuss the health benefits that can be achieved through regular moderate exercise.
3.
Write objectives to improve your fitness and wellness and develop a wellness programme for the future.
2.3
EMOTIONAL DIMENSION
Now let us look at another dimension of wellness which is emotional. It is hoped by learning about this dimension, you will be able to select suitable strategies to achieve balanced emotional wellness. The emotional dimension of health encompasses the ability to cope with stress such as remaining flexible and compromising to resolve problems. Please note that our ability to cope with stress will change as we age and as we learn new skills of managing our emotion. For example, young adults who are in the process of growth and development will experience emotional vulnerability, which may lead to feelings of rejection and failure. This can affect productivity and self-satisfaction (refer to Figure 2.6).
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Figure 2.6: Illustration of emotional vulnerability Source: http://media.cagle.com
On the other hand, the emotional dimension of wellness involves developing awareness and accepting oneÊs feelings. For instance, emotionally well people are able to express and manage their feelings effectively, maintain close relationships, deal with conflicts and remain grounded during stressful times. This is part of the continuous process of change and growth for young adult.
2.3.1
Emotional Stability
How do we relate emotional wellness with emotional stability? The answer lies within the definition of emotional wellness. Emotional wellness is defined as the ability to understand our own feelings, accept limitation and achieve emotional stability.
In other words, it is the ability to express emotions appropriately, accept change and cope with stress in a healthy way, and to enjoy life despite disappointments and frustrations. Now, what can we say about emotional stability? What does it stand for? Emotional stability is also the ability to look at success and failure in a positive manner.
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When success is evident, people who are emotionally well radiate with expected joy. On the contrary, when failure seems imminent, they respond by making the best of circumstances and move beyond failure. Last but not least, emotional wellness also involves happiness; it is seen as a long term state of our mind that permeates the various facets of life and influences our outlook. In other words, it means that true happiness signals exemption from tension and depression that many people endure.
2.3.2
Self-concept
Now we will discuss self-concept and self-esteem as part of emotional health. Firstly, the definition of self-concept. Do you have any idea what it means? Self-concept is how an individual pictures himself/herself internally, the way one sees oneself.
Self-concept is also the informational side of things, where you know facts about yourself. What about self-esteem? Self-esteem is how you feel about your own character and abilities. For example, whether you enjoy the fact that you are talkative (high self-esteem) or you think that you are annoying (low self-esteem).
Therefore, how can we achieve balanced emotional wellness? Well, here are some practices that will help to enhance your emotional wellness: (a)
Recognising conflict as potentially healthy rather than denying it;
(b)
Being responsible for your actions;
(c)
Reflecting on your feelings;
(d)
Accepting your feelings instead of denying them;
(e)
Accepting the feelings of others;
(f)
Seeking support, and guidance for uncontrollable feelings and emotions;
(g)
Building sturdy social support network;
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(h)
Practising positive financial behaviours to enhance security and emotional stability; and
(i)
Being open to continual personal and professional development.
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We can summarise that a person with emotional wellness will be able to: (a)
Possess a sense of humour;
(b)
Recognise own feelings and appropriately express them;
(c)
Strive to meet emotional needs; and
(d)
Be responsible for his or her behaviour.
SELF-CHECK 2.2 Differentiate between self-concept and self-esteem.
ACTIVITY 2.2 1.
Emotional growth requires both knowing about yourself and learning from new experiences. Consider the following scenario: Azman is a 30-year-old learner. He feels that he is being pulled in many different directions. Sometimes he thinks he is losing his sense of self or wonder if he ever had one. What can he do to help himself grow emotionally? Select the activities that you think can be used to foster AzmanÊs emotional growth. Discuss your plan in a group.
2.
Discuss strategies that can be implemented to enhance oneÊs selfmotivation.
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SPIRITUAL DIMENSION
This subtopic covers the spiritual dimension. Hopefully, you will be able to employ the spiritual support to enhance your wellness. The spiritual dimension of wellness is another endeavour after emotional wellness. The spiritual dimension of wellness involves exploring meaning and purpose in human existence. How do we recognise spiritual people? We can recognise them by their basic characteristics which include a sense of meaning and direction in life, and their relationship to the Creator. These characteristics then lead to personal freedom, prayer, faith, love, closeness to others, peace and altruism. Therefore, people with spiritual dimension of wellness possess the ability to integrate their beliefs and values into their daily actions. Please note that spiritual dimension of wellness is closely connected with religious beliefs and activities. Attending religious activities or meditation will not only result in better health by lowering the incidence of chronic disease, but also helps us handle stress more effectively (see Figure 2.7).
Figure 2.7: Animated stages on meditation Source: http://www.meditationcartoons.com
In fact, religious activities or meditation can also have a positive effect on our social lifestyle as they may help us in overcoming crisis and provide us with better coping techniques to deal with future trauma. Furthermore, in the spiritual dimension, prayer is the core of most spiritual experiences as a mode of communicating with our Creator. However, for effective results, we need to accept the efficacy of prayer and pray with sincerity, humility and love. Copyright © Open University Malaysia (OUM)
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Another key term under the subject of spiritual dimension is altruism. What does it stand for? Altruism means true concern for the welfare of others which enhance oneÊs health and longevity.
Did you know that altruism is a powerful attribute? It is so powerful that even watching films of altruistic endeavours would enhance the formation of an immune system which helps fight disease. What can we practise to increase our spiritual wellness? Well, here are some practices that can be adopted to increase your spiritual wellness: (a)
Possess a set of guiding beliefs;
(b)
Respecting beliefs and values of others;
(c)
Living in a way that is consistent with your principles;
(d)
Taking time for prayer or meditation;
(e)
Aware of the deeper meanings of everyday events; and
(f)
Spending time with nature.
To conclude, a person with spiritual wellness is able to: (a)
Examine his or her own personal values and beliefs;
(b)
Search for meanings that help explain the purpose of life;
(c)
Have a clear interpretation of right and wrong; and
(d)
Acknowledge natural forces in the universe.
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ACTIVITY 2.3 1.
Form a group and sit in a circle position. Prepare for a meditation exercise by playing background music on sounds of nature for a duration of 10 to 15 minutes. Discuss your experience with the group. Determine your level of tension and stress. Lastly, formulate a stress management programme for the group.
2.
What is the role of religion or spirituality in our health? To what extent should spirituality be part of the clinical encounter between patient and healthcare providers?
2.5
INTELLECTUAL DIMENSION
Finally, we come to the final subtopic which focuses on the intellectual dimension. It is hoped that by learning this dimension, you will be able to evaluate the significance of the intellectual dimension in your wellness. What is the intellectual dimension? Intellectual dimension is the ability to process and act on information, clarify values, beliefs and decision-making.
On other hand, intellectual wellness refers to active participation in scholastic, cultural and community activities. Besides that, other approaches such as valuing and nurturing creativity, curiosity and lifelong learning are part of intellectual wellness too. Hence, intellectually well people are open to new ideas, able to think critically, seek out new challenges and are more likely to maintain good cognition even as they age. In the other words, when you possess positive intellectual dimension, you are not intimidated by facts and figures with which you are unfamiliar, but you embrace the chance to learn something new. You are self-motivated to enhance your life in terms of further studies or professional development while holding your own ideas and philosophies.
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Furthermore, you will gain self-confidence which guarantees that you can take your place among others without having to give up part of yourself and without requiring others to do the same. Let us look at Figure 2.8 which shows you an example of self-motivation quotes.
Figure 2.8: Example of self-motivation quotes Source: https://s-media-cache-ak0.pinimg.com
What can we do to enhance our intellectual wellness? Well, here are some practices that will enhance your intellectual wellness: (a)
Learning to trust your ability to make good decisions;
(b)
Recognising and valuing learning as a life-long learning process;
(c)
Developing creativity and resourcefulness;
(d)
Being discerning when taking in information from TV, the Internet and newspaper; and
(e)
Critically analysing situations and solving problems.
As a conclusion, a person with intellectual wellness is able to: (a)
Communicate effectively orally and in writing;
(b)
See the bigger picture;
(c)
Keep abreast of current issues; and
(d)
Exhibit good time management skills. Copyright © Open University Malaysia (OUM)
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ACTIVITY 2.4 Reflect on your life experiences when you have been seriously ill. (a)
Describe how you feel about the nature and duration of the illness.
(b)
Discuss all the factors that you think might have contributed to your becoming sick.
(c)
Summarise all the factors that contributed to your getting well.
(d)
What do you think were the most important factors that led to your sickness?
(e)
What do you think were the most important factors in your healing process?
(f)
Write your reflective journal based on the above statement.
Please note that you need to include factors such as stress, emotional problems and poor nutrition. Also, you may include medical care, prayer, alternative medicines and other factors too.
There are eight dimensions to wellness, namely, physical, emotional, spiritual, intellectual, social, occupational, environmental and financial. In this topic, we have discussed the first four dimensions ă physical, emotional, spiritual and intellectual.
Physical activities that contribute to physical wellness are exercising regularly, taking a well-balanced diet, maintaining ideal body weight and minimising exposure to the environmental contaminants.
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Some strategies to achieve balance emotional wellness are:
Recognising conflict as potentially healthy rather than denying it;
Being responsible for your actions;
Reflecting on your feelings;
Accepting your feelings instead of denying them; and
Accepting the feelings of others.
Spiritual support to enhance wellness are:
Possessing a set of guiding beliefs;
Respecting others beliefs and values;
Living in a way that is consistent with your principles;
Taking time for prayer or meditation;
Awareness of the deeper meanings of everyday events; and
Spending time with nature.
Intellectual dimension in wellness is the ability to process and act on information, clarify values, beliefs and decision-making.
The significance of the intellectual dimension in wellness is that a positive intellectual dimension makes you more open to new ideas, able to think critically and seek out new challenges and more likely to maintain good cognition as you age.
Altruism
Physical wellness
Emotional wellness
Prayer
Intellectual wellness
Spiritual wellness
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American College of Sports Medicine (ACSM). (2000). Guidelines for exercise testing and prescription. Baltimore, MD: Williams & Wilkins. Edlin, G., & Golanty, E. (2010). Health and wellness (10th ed.). Sudbury, MA: Jones & Bartlett. Hoeger, W. K., & Hoeger, S. S. (2003). Lifetime physical fitness and wellness: A personalized program (7th ed.). Belmont, CA: Thomson Wadsworth. Payne, W. A., Hahn, D. B., & Mauer, E. B. (2005). Understanding your health (8th ed). New York, NY: McGraw-Hill. Stroebe, M., Schut H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960ă1973.
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Topic
3
Dimensions of Health and Wellness II
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Apply the strategies to enhance social wellness;
2.
Evaluate the factors that contribute to occupational wellness;
3.
Plan the strategies to promote environmental awareness; and
4.
Interpret financial wellness.
INTRODUCTION Can you still recall what the eight dimensions of wellness are? Can you list them? Well, the answers are mental, spiritual, occupational, environmental, financial, emotional, social and physical. In the previous topic, you have learnt the first four dimensions of wellness which are physical, emotional, spiritual and intellectual dimensions. Therefore, this topic will continue with the rest of the dimensions ă social, occupational, environmental and financial. Before we continue, let us reflect a little. Are you working and furthering your studies at the same time? How do you cope between them? Do you realise that occupational dimension of wellness is important for you? Occupational dimension of wellness is important to working adults. This is because they have to balance between studies and work, parenting and other responsibilities.
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So how do you balance your life with your study, family and work commitments? How about your social interaction skills? Are you able to participate in a group discussion? As a distance learner, you are expected to share your ideas, experience and knowledge with your course mates through interaction in the classroom or online discussion. Therefore, occupational and social skills are two important dimensions to be discussed in this topic along with the environmental awareness and financial aspects. Remember that all the eight dimensions are interconnected and influence each other. Are you ready to learn more? Let us continue with the lesson!
3.1
SOCIAL DIMENSION
Let us start the discussion by looking at the social dimension. Hopefully by learning this subtopic, you will be able to apply the strategies to enhance you social wellness. What can we say about the social dimension? Social dimension is described as the relationships that you have and how you interact with others.
In other words, this dimension involves building healthy, nurturing and supportive relationships with others to foster a genuine connection between you and your colleagues or those around you. Therefore, this subtopic will explore the significance of social dimension towards health and wellness especially to the young adult. The social dimension encourages us to involve or contribute to oneÊs environment and community. Thus, it is more on the interdependence between you and nature; you will feel that you are more aware of your importance in society as well as the impact you have on multiple environments. At the same time, you need to get involved or take an active part in improving our world by encouraging healthier living or healthy lifestyle and initiating better communication with those around you.
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So how do you achieve that? Well, in order to achieve social wellness, you need to actively seek ways to preserve the beauty and balance of nature. As you go along the pathway, you may discover the power to make wise choices to enhance personal relationships, the importance of friendships and finally build a better living space and community. How can we develop our personal social skills? Are they inherited from your parents? Or developed through life experience? Appropriate social skills are developed and nurtured throughout oneÊs adult years. During the process of becoming a young adult, we develop many interactions and form relationships with friends, work-mates and even parents. This may enable a person to develop social skills effectively beyond levels that they have achieved before. Therefore, for the young adult to achieve social wellness skills, they need to refine a variety of social skills including effective communication skills, listening skills and conflict management skills. In other words, it is a circle of social adaptations that we will naturally go through unconsciously as we age. The circle begins with family interactions, school experiences and peer group interaction that foster social skills development among young adults (see Figure 3.1).
Figure 3.1: Circle of social adaptations that foster social skills development among young adults Copyright © Open University Malaysia (OUM)
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At a later stage, we will develop new social skills with our colleagues when we enter college. The interaction at the higher institution will enhance the social dimension of health among the students, lecturers and others. Thus, the social dimension entails valuing living in harmony with course mates and housemates, seeking positive, interdependent relationships with others and developing good communication skills. This later develops into social wellness. What does social wellness refer to? Basically, social wellness refers to the ability to communicate and relate with others with a positive self-image. This positive self-image means that you are confident, outgoing, friendly and affectionate toward others. In addition, your own balance and sense of self allows you to extend respect and tolerance to others. On the other hand, social wellness is not only concerned about oneÊs self, but also an interest in humanity and the environment as a whole. Socially well adapted people are consciously enhancing their personal relationships, nurturing the importance of friendships to build a caring community. In other words, being socially well adapted will enhance your physical and emotional well-being. Today, we have another term named „social media‰. What does social media represent? Well, let us look at Figure 3.2 for the answer.
Figure 3.2: Social media is the modern communication mode Source: http://wronghands1.wordpress.com Copyright © Open University Malaysia (OUM)
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How can we enhance our social wellness? Below are some suggestions of practices that can enhance our social wellness: (a)
Create good rapport with others by building a strong social support network;
(b)
Practise effective communication skills with others;
(c)
Involve in many activities with people in a variety of settings;
(d)
Solve interpersonal conflict in a healthy environment and respectful manner;
(e)
Interact with people of other cultures, backgrounds and beliefs; and
(f)
Value the principles of time management.
In conclusion, social wellness is the ability of a person to develop relationships with friends and others. Such a person will have effective communication skills, contributes to the common welfare of the community, and live in a harmonious and healthy environment.
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ACTIVITY 3.1 1.
Using the Social Wellness Assessment by Hettler (1976), answer all the following questions and share your scores with your course mates. Social Wellness Assessment The social dimension of wellness involves developing, nourishing and encouraging satisfying relationships. Read each statement carefully and respond honestly using the following score: Almost always = 2 points
Sometimes/ occasionally = 1 point
Very seldom = 0 point
Statement I contribute time and/or money to social community projects. I am committed to a lifetime of volunteerism. I exhibit fairness and justice in dealing with people. I have a network of close friends and/or family. I am interested in others, including those from different backgrounds than my own. I am able to balance my own needs with the needs of others. I am able to communicate and get along with a wide variety of people. I obey the laws and rules of our society. I am a compassionate person and try to help others when I can. I support and help my family, neighbourhood and work social gatherings. Total for Social Wellness Dimension
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Score (Points)
Description
15 to 20
Excellent strength in this dimension.
9 to 14
There is room for improvement. Look again at the items in which you scored 0 or 1. What changes can you make to improve your score?
0 to 8
This dimension needs a lot of work. Look again at this dimension and challenge yourself to begin making small steps toward growth here. Remember that the goal is balanced wellness.
2.
Discuss the significance of social media in enhancing social wellness among young adults.
3.
Discuss the advantages and disadvantages of social media in promoting social wellness.
SELF-CHECK 3.1 Identify the six factors that contribute to social wellness.
3.2
OCCUPATIONAL DIMENSION
Now let us move on to the sixth dimension of wellness which is occupational. It is hoped that by learning this dimension, you will be able to evaluate the factors that contribute to occupational wellness. Try to reflect on these questions about yourself: Are you happy with your current job? Do you feel stress at work? What are the factors that contribute to your stress at the workplace? Well, these questions are related to occupational dimension. Let us discuss more on this matter, starting with its definition. Occupational wellness is described as routine demands which are mixed with new and unpredictable challenges that keep a job exciting, meaningful and rewarding.
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It also entails seeking for personal satisfaction and enrichment in oneÊs life through work. If you are able to achieve occupational wellness, you will find personal self-fulfilment and make a contribution to the well-being of the institution or community at large. In other words, occupational wellness is employment that provides personal satisfaction and enrichment in oneÊs life. The World Health Organization (WHO) (1994) stated that up to 58% of the worldÊs population spend one third of their adult life at work. We contribute actively to the development and well-being of themselves, our families and of society. This statistics means occupational wellness forms a crucial part of our overall sense of well-being. Trying to achieve a balance between work and no work related activity is the key to occupational wellness. Managing workplace stressors and building functional relationships with colleagues will contribute to your sense of occupational wellness too. Occupational wellness is also seen as a person doing exactly what he or she wants to do in life, that he or she feels comfortable with. This is related to their personal and professional development, financial situation and future plans. Hence, for many people, a healthy workplace environment that contributes to their sense of well-being need not be tied to a high salary or prestigious position. Salary might be the most important element for some people, but to others, it is more on value and creativity or work commitment. Conversely, to some people, the most important thing is the rewards rather than the job as people with occupational wellness will also face demands on the job. However, they also have some say over demands that are placed on them.
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Let us move on to the key issues in occupational wellness. What are they? Well, there are six key issues related to this dimension as described in Table 3.1. Table 3.1: Six Key Issues in Occupational Wellness Issue
Description
Stress
Ability to handle the stress that you are dealt every day at workplace.
Rewarding
Situations that you find personally rewarding.
Satisfaction
Workplace environment or situations that are meaningful and create a feeling of personal satisfaction.
Relationship
Ability to create and maintain interactions and relationships with people in the workplace.
Contribution
Ability to make contributions to the well-being of others and the community that will lead to a satisfying and meaningful feeling of being a contributing member to society.
Balance
Ability to get all our work done, besides having fun, and keeping the rest of our lives and other dimensions of wellness balance.
So, what would be the factors that contribute to occupational wellness? How do you encourage the culture of occupational wellness at your workplace? How about recognition from your superior or employer? Are they really appreciative of your contribution? You need to find ways to engage in creative and stimulating activities that allow you to maximise your skills or broaden existing skills and gain new ones. You can also take the opportunity for advancement and recognition of achievement. Not to forget to encourage collaboration and interaction among co-workers, which foster a sense of good teamwork and support. In addition, occupational wellness will allow you to find a path to explore your creativity, problem solving skills, and ways to learn more about your personal interests and the world around you. Furthermore, you can keep up with current events, find new ideas and to satisfy your intellectual curiosity that will allow you to continue to grow. However, occupation wellness may have positive or adverse effects on the health of the workers. In actual circumstances, work provides the income and material outputs that are necessities for life and at the same time, also have a positive impact on social, psychological and physical well-being. Moreover, a high level of occupational wellness will contribute to the achievement of material and Copyright © Open University Malaysia (OUM)
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economic objectives that will provide high quality and performance in the workplace. Unfortunately, choosing and obtaining a career that is personally and financially rewarding and enjoyable is difficult to achieve. Therefore, here are some suggestions to enhance your occupational wellness: (a)
You may have to find out what type of occupation interests you. Are you doing what you want to do with your life? Choose a career which is consistent with your personal values, interests and beliefs.
(b)
Learn how to achieve the right work life balance. You need to understand your work and learning styles so that you are able to work both independently and with others.
(c)
Be aware of your strength and weaknesses by exploring your talents and interests. You should talk to your manager or co-workers when a problem arises. Believe that you have the qualities of a valuable employee and is valued by others.
(d)
Commitment to contribute your unique skills for personal and professional development (in a meaningful and rewarding way).
(e)
Maintain a healthy work-life balance and seek professional development opportunities.
(f)
Lastly, do not forget to have some hobbies/interests/activities which bring you pleasure outside of work activities.
In conclusion, to achieve the occupational wellness, you need to choose a career that is consistent with your personal values, interests and beliefs. Thus, those with high occupational wellness will: (a)
Be involved in the exploration of new ideas;
(b)
Encourage stimulation, mental growth and intellectual activities; and
(c)
Make a huge difference in how they deal with situations as they project positive image and energy which can be a healing force to those around them.
Therefore, the choice of profession, job satisfaction, career development and personal performance are the most important components of occupational wellness. Copyright © Open University Malaysia (OUM)
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SELF-CHECK 3.2 1.
Define what occupational wellness is.
2.
State the most important components of occupational wellness.
ACTIVITY 3.2 1.
Discuss, in a group, the strategies to enhance occupational wellness at your workplace.
2.
Write a reflective journal on your work experience and relate it to occupational wellness.
3.3
ENVIRONMENTAL DIMENSION
Now let us move on to the environmental dimension. What is environmental wellness? Are you aware of the importance of environmental wellness? Indeed, it is important to lead a lifestyle that is respectful of our environment. Now, let us discuss environmental wellness in depth, so that by the end of this subtopic, you will be able to plan some strategies to promote environmental awareness. Firstly, what does environment wellness mean? Environmental wellness is described as a lifestyle that is supposed to be respectful of and in harmony with our environment.
In other words, you should be aware of the limits of the earthÊs natural resources and the impact of our actions on the environment. Environmentally well people consciously choose to live in ways that protect the world around them.
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However, in todayÊs climate, many people may still be unconcerned about what they can do to help with environmental wellness. As an individual, you do not have to be a member of an organisation. You can help by simply leading an environmentally conscious life. How do you contribute to environmental wellness? Well, you can contribute by emphasising the importance of living in a healthy environment by ensuring the purity of water, air and living conditions. At the same time, if you see someone littering, what you should do is just politely tell that person you do not approve of his or her actions. You may contribute to increasing environmental wellness by getting actively involved in your community recycling programmes, by educating the community on the significance of the programme, and implementing a recycling programme such as finding ways to conserve the use of paper in your home and workplace. Do not forget to have regular meetings with your community or society to ensure they support and are actively involved in the programme. Make sure the recycling bins available in your home and workplace are being utilised (see Figure 3.3).
Figure 3.3: Recycling bins Source: http://recyclingrangers.blogspot.com Copyright © Open University Malaysia (OUM)
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Environmental wellness also includes the ability to promote measures that improve the standard of living and quality of health in our environment. Hence, it is actually our personal, community and societyÊs responsibility to educate and protect us against environmental hazards. It is important to note that we also need to protect the environment so that our children and our future generations can live in a safer and clean environment. For example, if we take account of the recent haze problem that affected our environment, most of us were unaware of its danger to our health. We need to educate people to take this situation seriously in order to keep their family and children safe from haze. This is to prevent any sickness as haze causes many respiratory problems as well as skin diseases (refer to Figure 3.4). Therefore, precautions and quick judgment against environmental pollution may lead to environmental wellness.
Figure 3.4: Haze hazard Source: https://s-media-cache-ak0.pinimg.com
Have you heard about the environmental theory? What does it mean? Environmental theory is a theory formulated by Florence Nightingale (the founder of modern nursing) in which she focused on taking care of the patient's environment in order to reach health goals and cure illness. Copyright © Open University Malaysia (OUM)
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Basically, the focus of this model in nursing is to alter the patientÊs environment in order to affect change in his or her health. Florence Nightingale believed that the environmental factors will affect health (as described in the theory) such as fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of the patient and bright light (particularly direct sunlight). In case any of these factors is lacking, the patient may experience diminished health. However, some aspects of the theory may not be relevant in todayÊs environment. Do you know why? Let us take direct sunlight and good ventilation for instance. Nightingale mentioned that the door should be closed and windows opened, in order to let in direct sunlight and provide good ventilation. However, in the real situation today, all doors and windows are closed as we are using air conditioning system in the hospitals. In situations where the air conditioning system is not in place, windows and doors are opened to allow free movement of air and ventilation but still, they should be checked for efficiency to ensure the air is free from microorganisms. In order to ensure environmental safety in the hospital, all the air condition systems, especially in the operation theatre, must be checked regularly to detect the presence of any microorganism. So, how do we enhance environmental wellness? Well, here are some tips for you to practise: (a)
You may prefer to ride a bicycle instead of drive a car;
(b)
You need to appreciate and respect nature;
(c)
You need to protect yourself and others from environmental hazards. It could be from second hand smoke, noisy environment, air and water pollution, and also ultraviolet radiation; and
(d)
You need to educate yourself on environmental issues.
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ACTIVITY 3.3 1.
In a group, discuss the following environmental wellness issues: (a)
Awareness of the limits of the earthÊs natural resources.
(b)
Conserve energy such as switch off unused light.
(c)
Recycle paper, cans and glass as much as possible.
(d)
Enjoy, appreciate and spend time outside in natural settings.
(e)
Do not pollute the air, water or earth if you can avoid doing so.
(f)
Avoid second-hand smoke. (www.definitionofwellness.com)
Plan suitable activities for each issue to enhance environmental awareness among community/population. 2.
3.4
Discuss some strategies to inculcate environmental awareness among your community today.
FINANCIAL DIMENSION
Lastly, let us look at the financial dimension. Hopefully, by the end of this subtopic, you will be able to interpret financial wellness. Did you realise that financial wellness is a relatively new dimension? It is considered new as it is the last dimension of health and wellness. It was generally adopted as the eighth dimension in the aftermath of the Great Recession of December 2007 to June 2008.
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So what does financial wellness mean? Let us look at a definition given by LiveLifeWell.co (2015). „Financial health and wellness can be defined as a „state‰, „level‰ or „quality‰ of a personÊs financial position or wealth. Wealth can be created, conserved or lost and will fluctuate between changing circumstances.‰ LiveLifeWell.co (2015)
The changing circumstances can be various. Some of them are amenable to control while some are not. Knowing the characteristics of each of the relevant forces during the period is of utmost importance. The idea is to enable one to undertake adequate steps to minimise the exposure of oneÊs asset to the negative effects of the environmental forces.
3.4.1
The Impetus that Led to the Creation of a Financial Wellness Programme
The National Bureau of Economic Research (NBER) in 2014 dated the beginning of the recession as December 2007. In the US, roughly 8.7 million jobs were shed from February 2008 to February 2010. The gross domestic product (GDP) contracted by 5.1%, making the Great Recession the worst since the Great Depression. In addition, the Great Recession led to: (a)
Unemployment and underemployment;
(b)
Job shortage; and
(c)
Falling income, rising poverty.
The recession led to the bursting of the housing bubble and the nose-diving of the stock market and the consequent drop in family wealth. A great deal of stress ensued too. People become stressed over money and this has taken both a mental and physical toll on workers, impacting health-related costs and reducing productivity by a significant number.
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3.4.2
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DIMENSIONS OF HEALTH AND WELLNESS II
Financial Wellness at the Workplace
Did you know that assessment of findings at workplaces indicates financial problem as the main determinant of financial stress among employees? Those with higher level of financial problems experienced higher level of financial stress which led to the decline of the level of financial well-being. However, it is observed that among all predictors, financial stress has the highest effect (a negative effect) on financial well-being. It can be assumed that reducing the level of employeesÊ financial strain will improve their satisfaction towards finance aspects. In addition to meeting regulatory obligations to monitor employeesÊ trading activity, some firms offered financial education and wellness programmes to help improve their employeesÊ ability to manage their personal finances. Financial wellness programmes may help reduce employee absenteeism, boost productivity and increase employeeÊs loyalty. We are sure you agree that employeesÊ financial problems become the employerÊs problems as well. Financial wellness and the workplace that fosters it can go a long way towards providing solutions that increase productivity and peace of mind. Employees who experience financial wellness are happier and potentially more productive employees to the company.
SELF-CHECK 3.3 State three benefits of financial wellness programme to employees.
ACTIVITY 3.4 Read Delafrooz, N., & Paim, L. (2013). Role of financial stress on relationship between financial problem and financial wellness among Malaysia workers. African Journal of Business Management, 7(20), 1966-1972 at http://goo.gl/MDdUMw. In groups of four, discuss the interrelationship among financial problem, financial behaviours, financial stress and financial wellness.
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Social wellness is about the relationship with others. It involves building healthy, nurturing and supportive relationships with others to foster a genuine connection between you and your colleagues or those around you.
Some of the strategies to enhance social wellness are to build good rapport with others by a strong social support network, practise effective communication skills with others, interact with people of other cultures, backgrounds and beliefs, and value the principles of time management.
Occupational wellness is pertaining to employment that provides personal satisfaction and enrichment in oneÊs life.
Some factors that may contribute to occupational wellness are choice of profession, job satisfaction, career development and personal performance.
Environmental wellness is one of the important dimensions in health and wellness. It focuses on the awareness of the individual, the community and the society to prevent environmental hazards.
Some strategies that can be implemented to promote environmental wellness are the recycling campaign to educate and protect us against environmental hazards, and developing an appreciation of nature, and respecting it and all species living among nature.
Financial wellness is a relatively new dimension and was generally adopted as the eighth dimension in the aftermath of the great recession of December 2007 to June 2008. It can be defined as a state, level or quality of a personÊs financial position or wealth.
Environmental wellness
Occupational wellness
Financial education and wellness programmes
Personal satisfaction and enrichment
Financial wellness
Recycling Social wellness
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Hettler, B. (1976). The six dimensions of wellness. Retrieved from http://www.nationalwellness.org/?page=Six_Dimensions Hoeger, W. K., & Hoeger, S. S. (2003). Lifetime physical fitness and wellness, a personalized program (7th ed.). Belmont, CA: Thomson Wadsworth. LiveLifeWell.co. (2015). Financial wellness. Retrieved from http://livelifewell.co/category/wellness/wellness_financial/wellness_fina ncial.php National Bureau of Economic Research (NBER). (2014). Economic report of the president. Retrieved from http://www.nber.org/erp/2014_economic_report_of_the_president.pdf Payne, W. A., Hahn, D. B., & Mauer, E. B. (2005). Understanding your health (8th ed). New York, NY: McGraw-Hill. Petiprin, A. (2015). Nightingale environment theory. Retrieved at http://www.nursing-theory.org/theories-and-models/nightingaleenvironment-theory.php World Health Organization (WHO). (1994). Global strategy on occupational health for all: The way to health at work. Retrieved from http://www.who.int/occupational_health/publications/globstrategy/en/
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Topic
4
Understanding Nutrition and Diet
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Identify the components of healthy diet;
2.
Distinguish the dietary challenges for special groups;
3.
Compare healthy diet versus therapeutic diet; and
4.
Plan for healthy diet.
INTRODUCTION Let us begin our lesson in this fourth topic by looking at these quotes (refer to Figures 4.1 and 4.2).
Figure 4.1: Hippocrates (from 460BC to 370BC) ă Greek physician of the Age of Pericles Source: www.azquotes.com Copyright © Open University Malaysia (OUM)
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Figure 4.2: Terri Guillemets (1973) ă quotation anthologist Source: www.vebidoo.com
Have you ever heard of all these quotes? Do you understand their meanings? How does medicine relate to food? Can our bodies really run on fresh green fuel? Imagine how this really happens in life! IsnÊt that interesting? These quotes are related to healthy diet and healthy food intake to improve our lives tremendously. This topic will enhance your understanding of nutrition and diet. In addition, there are a few related activities that can assist you to gain a better understanding of this topic. As a working adult, it is very important for you to understand the basic information about nutrition and diet so that you benefit from the knowledge gained. Do you agree that food is a source of pleasure? This is what some people say. There are many reasons why people eat the way they do and it is true that food is much more than a tool of survival. Food can be a source of comfort, a symbol of hospitality and also an indicator of social status. For whatever reason, remember that food also can be the source of our sickness. So, how do we prevent ourselves from getting sick because of our food? Food is generally good but it can also get you into trouble. So, how do we stay healthy? Well, first of all you need to ask yourself „Am I eating right?‰ Next is awareness. By increasing your awareness of healthy eating, you can prevent yourself from getting sick. Most people are aware of the role of nutrition in health and they want to eat better for health purposes but fail to translate their desire into proper action.
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Poor eating habits span all age groups. Healthy eating is a growing factor of concern in many countries due to the increase in cases of overweight and obesity, not only in Malaysia but worldwide. Modern lifestyles such as eating late and young generations relying on fast food have led to eating disorders. The Ministry of Health Malaysia has implemented various policies and campaigns to promote healthier eating behaviour among the public. Some of the campaigns are Healthy Lifestyle Campaign, Reduce Sugar Intake Campaign and Guidelines on the Implementation of Healthy Eating in the Public Sector which have been launched at national level. A revised version of Malaysian Dietary Guidelines (MDG) was launched in 2010, comprising 14 messages and 55 recommendations to a healthy diet. The objectives of this guideline are to promote healthy eating, regular exercise and effective use of nutrition information on food labels (Tee, 2011). You can have your own copy of this guideline at http://goo.gl/eUrivj. In order to eat right or plan your diet, you need to know the components of a healthy diet. Therefore, this topic will teach you how to do this and then, you will be able to choose your right diet according to your body requirements. Remember: to stay and maintain a healthy lifestyle, you need to exercise too!
4.1
COMPONENTS OF HEALTHY DIET
What do you understand about the components of a healthy diet? Do you think that by eating a tuna sandwich with some cucumber in it and drinking a glass of fresh milk, you will get proper components for a healthy diet? What are the important nutrients contained in those foods? Let us check the contents based on the food pyramid that dieticians always recommend for a healthy diet (refer to Figure 4.3).
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Figure 4.3: Food pyramid Source: www.healthworks.my
Based on Figure 4.3, can you identify the contents in these foods? Generally, our body requires proteins, fats, carbohydrates, vitamins, minerals and water which can be found in the food we eat. These are called essential nutrients, which mean you must get these substances from the food you eat because your body is not able to manufacture them at all. Now let us look at these nutrients further in the next subtopics.
4.1.1
Proteins
Did you know that proteins are the basics of our body structure? Proteins form an important part of the bodyÊs main structural components (muscles and bones) and also form important parts of blood, enzymes, some hormones and cell membranes (Insel & Roth, 2008). What are proteins composed of? Proteins are composed of chains of amino acids. Amino acids are the „brick‰ from which the body constructs its own protein. In our body, we use 20 amino acids in various combinations to build the protein required for physiological processes so that we can continue to be healthy (Williams, Anderson & Rawson, 2013).
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The maintenance of body tissue is essential because the body is constantly undergoing wear and tear, so proteins and amino acids provide continuous repairs. What does wear and tear mean? Wear and tear mean that everyday our tissues and cells die and will be replaced with new ones. In addition, proteins act as a shield too. They will defend the body against various diseases. When the body detects any invading antigens, they will manufacture antibodies and giant protein molecules designed specifically to combat the antigens. Where can we get the proteins? What kind of diet contains proteins? Proteins in the human diet come from the following two main sources: (a)
Animal proteins (such as egg, milk, meat and fish); and
(b)
Plant proteins (such as cereals, nuts, beans and soy products).
ACTIVITY 4.1 Form small groups during your tutorial and discuss the importance of proteins in the diet, according to age groups.
4.1.2
Carbohydrates
You have learnt that protein makes up the basic structure of the body. How about carbohydrates? What is the role of carbohydrates in our body? Well, let us look at its definition first. Carbohydrate is a combination of sugar units and the major energy source for the body.
In fact, each gram of carbohydrate contains four calories. Carbohydrates occur in three forms ă monosaccharide, disaccharide and polysaccharide. I am sure you are familiar with glucose. Did you know that glucose is one of the most important monosaccharide? It makes up the blood sugar used as the bodyÊs primary source of energy. In addition, it is the sole source of energy for the brain and nervous system.
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What will happen if the brain and nervous system do not have adequate energy? Lack of glucose can result in weakness, dizziness and low blood glucose (hypoglycaemia). Reduced blood glucose during exercise decreases performance and could lead to mental as well as physical fatigue. All the cells and tissues in our body need carbohydrates. Furthermore, they are also important for intestinal health and waste elimination. In fact, carbohydrates are easily converted to fuel once they entered our body. There are two types of carbohydrates, which are simple and complex. Simple carbohydrates (also called simple sugars) include sugars found in fruits, vegetables and milk, as well as sugars added during food processing. How about complex carbohydrates? Complex carbohydrates (also called starches) include whole-grain breads and cereals, starchy vegetables and legumes. Most complex carbohydrates contain fibre which helps digestive health and increases satiety (feeling full), reducing overeating and weight gain. In addition, high-fibre foods help lower cholesterol and decrease the risk of heart disease. Now let us look at the functions of carbohydrates. What are they? Do you have any idea? Let us look at Table 4.1 for the answers. Table 4.1: Functions of Carbohydrates Function
Description
Provide energy
Carbohydrates are like a fuel source in our body. When you eat foods that contain carbohydrates, your body will break them down into glucose for better absorption.
Spare protein
It is used for energy due to the lack of carbohydrates.
Maintain digestive health
Fibre is one carbohydrate that is necessary for digestive health. The main function is to help prevent constipation and diarrhoea and also helps you feel full longer, which helps you avoid overeating.
Stimulate growth of bacteria in intestines
Carbohydrates that ferment in your intestines will stimulate the growth of bacteria. This bacteria helps to break down food so that it can be used by the body. Some bacteria protect the colon from harmful cells such as cancer. The foods that stimulate this type of bacteria are known as prebiotics. Prebiotics are very important for intestines health and you may want to consume it in tablet or liquid form. For example, yogurt drinks such as Yakult or Vitagen.
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ACTIVITY 4.2 Think of one recipe for your lunch to ensure you get enough portions of carbohydrates. Discuss with your course mates during tutorial and share your findings.
4.1.3
Fats
Now let us turn our attention to fats. Did you know that fats are also known as lipids? The fats stored in our body represent usable energy, they help insulate our body, and they support and cushion our organs. Fats in the diet help our body to absorb fat-soluble vitamins (A, D, E and K) as well as add important flavour and texture to foods. In addition, fats are the major fuel for the body during rest and light activities. There are two types of fats ă linoleic acid and alpha-linolenic acid. They are essential components of our diet. They are used to make compounds that are key regulators of body functions such as the maintenance of blood pressure and the progress of healthy pregnancy. The functions of fats are further explained in Table 4.2. Table 4.2: Functions of Fats in the Body Function
Description
Energy
Carbohydrates are the main source of fuel in our body. Sometimes our body system turns to fat as a backup energy source when carbohydrates are not available.
Vitamins absorption
Some types of vitamins rely on fat for absorption and storage. Vitamins A, D, E and K (called fat-soluble vitamins) cannot function without adequate daily fat intake. These vitamins are essential parts of your daily diet. Absorption of these vitamins may be compromised without proper diet.
Insulation
Fat cells, stored in adipose tissue, insulate your body and help to sustain normal body temperature. Adipose tissue is not always visible, but if you are overweight, you may be able to see it under your skin. Stored fats surround vital organs to keep them protected from sudden movements or outside impacts.
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Did you realise that most of the fats that we eat are „hidden‰ in food? This is because they have been incorporated during the preparation or cooking method such as frying. Every type of dietary fat is made up of a combination of three fats ă saturated, monounsaturated and polyunsaturated, based on the chemical composition. Take note that we are not going to learn about the details of these forms of fats but as consumers, we need to pay attention to the amount of each type in our diet because of their role in heart disease. Furthermore, different types of fats have different effects on health especially cholesterol level and risk of heart disease. Saturated and trans fatty acids raise the blood level of low-density lipoprotein (LDL). This is the bad cholesterol that enhances risk of heart problems. Monounsaturated fatty acids can be found in olive or canola oils. This type of fatty acid can increase high-density lipoproteins (HDL) which is also known as good cholesterol. Can you identify which fats are good and which are not? Let us look at Figure 4.4 for an answer.
Figure 4.4: Good and bad fats Source: https://blogs.otago.ac.nz
Saturated fats have been found to impair the ability of HDLs to prevent inflammation of blood vessels and reduce their ability to react normally to stress, thus reducing the risk of heart disease. So it is important for us to choose unsaturated fats instead of trans or saturated fats.
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How do we reduce both saturated and trans fat in our diet? The best way is to lower your intake of meat and full-fat dairy products (whole milk, cream, butter, yogurt and ice-cream). How about trans fats? Do you like to eat French fries? If you do, please reconsider because deep-fried food, crackers, cookies and baked goods contain trans fat which is not so good for your health.
ACTIVITY 4.3 Discuss the relationship between good and bad fats and how these fats can lead to heart disease. Then, suggest ways to prevent it.
4.1.4
Vitamins
What do you understand about vitamins? We have heard about all types of vitamins but how far do we understand the importance of vitamins in our diet? Should we take supplements to ensure we have adequate vitamins? These are the questions people always ask when they plan to buy additional vitamins. Now, let us look at the details of vitamins. Firstly, its definition. Vitamins are organic compounds required in small amounts for normal growth, reproduction and maintenance of health.
Take note that vitamins do not serve as calories but serve as coenzymes. By facilitating the actions of enzymes, vitamins help initiate a variety of body responses including energy production, use of minerals and growth of healthy tissues. As human beings, we need 13 types of vitamins; four are fat-soluble (A, D, E and K) and nine are water-soluble (C and the 8 B-complex vitamins such as thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, biotin and pantothenic acid). Water-soluble vitamins are absorbed directly into the bloodstream (Insel & Roth, 2008). Vitamins are important to unleash energy stored in carbohydrates, proteins and fats. They are critical in the production of red blood cells and the maintenance of the nervous, skeletal and immune systems. Some of them act as antioxidants which help preserve healthy cells in the body.
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Where can we easily get vitamins? Forget about the bottled ones in the pharmacies! Let us look at the natural sources. Vitamins are abundant in fruits, vegetables and grains. In fact, our skin makes vitamin D when exposed to sunlight and our intestinal bacteria make vitamin K. What will happen if you donÊt get enough vitamins? Vitamins deficiency will lead to a lot of problems. For example, vitamin A deficiency can cause blindness and vitamin B6 deficiency can cause seizures. But remember! If you consume extra vitamins, it will cause you harm too! For example, high doses of vitamin A are toxic and increase risk of birth defects while excessive intakes of vitamin B6 can lead to irreversible nerve damage. Let us look at Table 4.3 which shows you the water-soluble vitamins and their functions. You might want to remember these functions to ensure you get adequate dose. Table 4.3: Water-Soluble Vitamins and Their Functions Vitamin
Function
B1 (thiamin)
Releases energy from carbohydrates.
B2 (riboflavin)
Releases energy from protein, fat and carbohydrate.
Promotes healthy skin and eyes.
Releases energy from protein, fat and carbohydrate.
Involved in cholesterol production.
B5 (pantothenic acid)
Releases energy from carbohydrate, fat and protein.
B6 (pyridoxine)
Breaks down protein.
Helps to make red blood cells.
Helps to make red blood cells, nerve cells and genetic material (DNA).
Breaks down carbohydrate and fat.
Helps to make red blood cells and enzymes and prevents neural tube defects.
Breaks down DNA material and reduces levels of homocysteine (high levels are a risk factor for cardiovascular disease).
B3 (niacin)
B12 (cyanocobalamin)
Folate (folic acid)
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Biotin
C (ascorbic acid)
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Breaks down fat and protein.
Promotes growth and healthy nerve cells.
Forms collagen (an essential component of the skin, blood vessels, bone and teeth).
Acts as an antioxidant, providing resistance to infections and promoting wound healing.
Improves non-harm iron absorption. Source: Carruthers (2006)
Table 4.4 explains fat-soluble vitamins and their functions. Table 4.4: Fat-Soluble Vitamins and Their Functions Vitamin
Function
Maintains healthy skin and eyes, improving vision at night and in dim light.
Acts as an antioxidant, having a role in cancer prevention.
Vitamin D (cholecalciferol)
Promotes strong bones and teeth.
Vitamin E (tocopherols)
Maintains healthy cell membranes.
Acts as an antioxidant.
Vitamin K (phylloquinone)
Needed for blood clotting.
Vitamin A (retinol)
Source: Carruthers (2006)
ACTIVITY 4.4 Do you think that by exposing yourself to direct sunlight, you can get enough vitamin D? Discuss the pros and cons of this method with your tutor.
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Minerals
Why do we need minerals? Minerals are important elements to regulate body functions, aid in the growth and maintenance of body tissues, and help release energy. They are also critical in the regulation of a number of body processes, including fluid balance, nerve impulses, muscle contraction, heart function, blood clotting, protein synthesis and red blood cell synthesis. For your information, there are about 17 essential minerals that your body needs including calcium, phosphorus, magnesium, sodium, potassium and chloride. Essential minerals are divided into major minerals (macro minerals) and trace minerals (micro minerals). These two groups of minerals are equally important, but trace minerals are needed in smaller amounts than major minerals. Examples of macro minerals are calcium, phosphorus, sodium, potassium and magnesium whereas micro minerals consist of zinc, iron, copper, selenium and iodine. Can you name some examples of food that contain the minerals? Examples of food that contain minerals are lean meats (rich in iron), dairy products (excellent source of calcium). Green leafy vegetables, white and sweet potatoes, banana and other fruits contain potassium.
SELF-CHECK 4.1 Name all the nutrients that we need to stay healthy and give three examples for each.
4.1.6
Water
I am sure you are aware that water is the major component in our body and in foods. Generally, people can die if they do not have water for certain periods due to dehydration. Our body is made up of 50 to 60% water. Water forms the basis of blood, digestive juices, urine and perspiration, and is contained in lean muscle, fat and bones. Why do we need water? Our body needs water to regulate body temperature; water plays a key role in nearly all of the bodyÊs biochemical reactions. However, most people never seriously think about the importance of water for their body. In fact, many of us obtain fluids from fruits or vegetables rather than drink it straight. Copyright © Open University Malaysia (OUM)
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Here are some interesting facts about water for you to know (Better Health Channel, 2015): (a)
Body water content is higher in men than in women and falls in both with age;
(b)
Most mature adults lose about 2.5 to 3 litres of water per day. Water loss may increase in hot weather and with prolonged exercise;
(c)
Elderly people lose about two litres per day;
(d)
An air traveller can lose approximately 1.5 litres of water during a threehour flight; and
(e)
Water loss needs to be replaced.
What are the risks if we do not drink enough water? Inadequate water intake can increase the risk of kidney stones and urinary tract infection, especially in women! It can also lower our physical and mental performance and lead to dehydration. How do you know when your body needs water? A small amount of dark-coloured urine can be the indicator that you are not consuming enough water! Do you know what the solution is? Drink a lot of water (recommended eight glasses per day) as clear or pale coloured urine is the indicator for enough fluids in your body.
4.1.7
Dietary Challenges for Special Groups
Let us now discuss about dietary challenges for special groups of people. Who are those categorised as special groups? They are children and teenagers, college students, older adults, athletes and pregnant women. Generally, people from different age groups will need different types of food. For example, young people need to consume a variety of foods. Children and teenagers, often need encouragement to eat vegetables and fruits. This group usually loves to take fast food that contain more sodium and preservatives than healthy fresh foods. The best thing a parent can do is to provide children with a variety of foods. College students always choose to consume unhealthy food because of their daily activities. Some colleges provide dining hall or food court that does not offer food that is high in nutrients or low in fat. They also love to grab fast food meals because of their busy schedules.
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Take note that nutrients are not changing so much as people age, but older adults tend to become less active and they require fewer calories to maintain body weight. Because of the age-related changes in digestive tract, their body also have problems with the absorption of nutrients. Thus, they need to consume nutrientdense food in order to meet their body nutritional requirement. Becoming an elite athlete requires good genes, good training and conditioning, and not forgetting, a sensible diet. Optimal nutrition is essential for peak performance. The most important aspects for athletes are to increase their energy requirement and make sure they take enough fluids during their training to remain hydrated. Here are some guidelines for athletes: (a)
Athletes can achieve peak performance by frequent training and eating a balanced diet that includes a variety of foods;
(b)
Carbohydrates and fat can provide fuel for their body;
(c)
The use of fat as a fuel source depends on the intensity and duration of the exercise, and the athleteÊs condition;
(d)
Exercise will increase the athleteÊs need for protein; and
(e)
Water is a very critical nutrient for all athletes. Without enough intake of water, dehydration may occur and cause muscle cramps and fatigue. Furthermore, these conditions will increase the risk of heat stroke.
In order for you to understand the types of diet, further discussion in the next subtopic will enable you to see the differences between healthy and therapeutic diets. Let us continue our lesson!
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ACTIVITY 4.5 1.
Discuss with your tutor the appropriate diet for 6-year-old boys and girls. Provide an appropriate diet that these children should take.
2.
Form two groups and debate these statements:
4.2
(a)
Every time you eat or drink, you are either feeding disease or fighting it.
(b)
Do not eat less, eat right.
HEALTHY VERSUS THERAPEUTIC DIET
Before we end our lesson on nutrition and diet, let us discuss the issues between healthy diet and therapeutic diet. It is hoped that by the end of this subtopic, you will be able to differentiate between healthy diet and therapeutic diet.
4.2.1
Healthy Diet
Did you realise that healthy eating is not about strict dietary limitations, staying unrealistically thin, or depriving yourself of the foods you love? Actually, it is more about feeling great, having more energy, improving your outlook and stabilising your mood. All of us know that eating right can help you maintain a healthy weight and avoid certain health problems. But what happens if your diet has a profound effect on your mood and sense of well-being? That is why if you want to stay healthy, you need to take a healthy diet. Eating more fruits and vegetables, cooking meals at home, and reducing your fat and sugar intake, on the other hand, will help to improve mood and lower your risk for mental health problems. If you have already been diagnosed with a mental health problem, eating well may even help you to manage your symptoms and regain control of your life. This shows the power of food. How do we ensure we follow a healthy diet? You do not need to be perfect and completely eliminate foods you enjoy to have a healthy diet that will make a difference to the way you think and feel.
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Here are some tips for planning a healthy diet (Robinson, Segal & Segal, 2015): (a)
Easy Tips for Success (i)
Prepare your own meals: Cooking meals at home will help you take charge of what you are eating. You can monitor exactly what goes into your food.
(ii)
Make the right changes: Choose healthy foods only for your diet.
(iii) Simplify: Count your calories; think of your diet in terms of colour, variety and freshness. Avoid packaged and processed foods and opt for more fresh ingredients. (iv) Read the labels: Be aware of what is in your food such as hidden amounts of sugar and salt in packaged food. (v)
(b)
(c)
Your feelings after eating: This will help to foster healthy new habits and tastes. The more healthy food you eat, the better you will feel after a meal. Do not eat junk food as it causes more harm than good.
Drink Plenty of Water (i)
Water can help in flushing our systems of waste products and toxins.
(ii)
You may get dehydrated if you do not drink enough water and the symptoms are tiredness, low energy and headaches.
Moderation is the Key for Success (i)
It means eating when you are hungry.
(ii)
You should feel satisfied after eating, but not stuffed.
(iii) Get a balanced diet: Protein, fat, fibre, vitamins and minerals to sustain a healthy body.
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(d)
(e)
(f)
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Fill Up on Colourful Fruits and Vegetables (i)
Fruits and vegetables are low in calories and nutrient dense. Focus on eating the recommended daily minimum of five servings of fruits and vegetables.
(ii)
Try to eat a variety of colourful fruits and vegetables every day as deeply coloured fruits and vegetables contain higher concentrations of vitamins, minerals and antioxidants. You may add berries to breakfast cereals, fruit for dessert and snack on vegetables such as carrots, snow peas or cherry tomatoes instead of processed snack foods.
Eat More Healthy Carbohydrates and Whole Grains (i)
Healthy carbohydrates (or good carbohydrates) include whole grains, beans, fruits and vegetables. Healthy carbohydrates are digested slowly, helping you feel full longer, and keeping your blood sugar and insulin levels stable.
(ii)
Unhealthy carbohydrates (or bad carbohydrates) are foods such as white flour, refined sugar and white rice that have been stripped of all bran, fibre and nutrients. They digest quickly and can cause spikes in blood sugar levels and energy.
Reduce Sugar and Salt (i)
Sugar not only creates weight problems but it also causes energy spikes. In addition, it has been linked to diabetes, depression and increase in suicidal behaviours for some people.
(ii)
That is why we need to reduce the amount of candy and desserts that we eat. However, it is only part of the solution as sugar is also hidden in foods such as bread, cereals, canned soups and vegetables, pasta sauce, margarine, instant mashed potatoes, frozen dinners, low-fat meals, fast food and ketchup.
(iii) Sodium is another ingredient that is frequently added to food to improve taste. However, our body actually does not need much sodium in our daily intake. (iv) Taking too much salt can cause high blood pressure and lead to an increased risk of stroke, heart disease, kidney disease, memory loss and erectile dysfunction. Copyright © Open University Malaysia (OUM)
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UNDERSTANDING NUTRITION AND DIET
Therapeutic Diet
Now we move on to therapeutic diet. What is therapeutic diet? A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients.
It is part of the treatment of a medical condition and is normally prescribed by a physician and planned by a dietician. A therapeutic diet is usually a modification of a regular diet; it is modified or tailored to fit the nutrition needs of a particular person (IHSS Training Academy, n.d.). For this module, the discussion on therapeutic diet will focus on diabetes, high blood pressure and renal diet only. You can get more information on other diseases from textbooks or the Internet. Why do we just focus on these three major diseases? This is because these diseases are very common nowadays and they can affect the public at any age. (a)
Therapeutic Diet for Diabetes First of all, what is diabetes? Diabetes is a chronic disorder characterised by high blood glucose and either insufficient or ineffective insulin; depending on the type of diabetes.
What is the function of insulin? The function of insulin is to help in maintaining blood glucose within normal limits and stimulates protein synthesis, glycogen synthesis in liver and muscle as well as fat synthesis (Whitney & Rolfes, 2002). So, what is a diabetes diet? In the medical field, it is also known as medical nutrition therapy (MNT) for diabetic patients. It is about eating a variety of nutritious foods in moderate amounts and following regular mealtimes. It is not a restrictive diet but MNT is a healthy-eating plan that is naturally rich in nutrients and low in fat and calories. In fact, this diet emphasises fruits, vegetables and whole grains; it is the best eating plan for everyone to stay healthy.
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What are the recommended foods for diabetes patients? Recommended foods for diabetes patients are as follows: (i)
Healthy carbohydrates: Patients can take fruits, vegetables, whole grains and low-fat dairy products for simple carbohydrates.
(ii)
Fibre-rich foods: They are important to reduce risk of heart disease and help in controlling blood sugar control. For examples, vegetables, fruits, beans, nuts, whole-wheat flour and wheat bran.
(iii) Fish: Patients can eat fish at least twice a week. Fish can be a good alternative to high-fat meats. For example, cod, tuna and halibut have less total fat, saturated fat and cholesterol than meat and poultry. Fish such as salmon, mackerel, tuna and sardines are rich in omega-3 fatty acids, which can promote heart health by lowering blood fats called triglycerides. (iv) ‰Good‰ fats: Most fats are high in calories. However, foods that contain monounsaturated and polyunsaturated fats like avocados, almonds, pecans, walnuts, olives, canola oil, olive oil and peanut oil can help lower your cholesterol levels. Take note that diabetes can increase your risk of heart disease and stroke by accelerating the development of clogged and hardened arteries. The following are foods that you need to avoid if you have diabetes: (i)
Saturated fats: High-fat dairy products and animal proteins such as beef, hot dogs, sausage and bacon contain a lot of saturated fats. You should limit these foods to ensure you can stay healthy.
(ii)
Trans fats: These fats are found in processed snacks, baked goods, shortening and stick margarines, and should be avoided completely.
(iii) Cholesterol: Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, shellfish, liver and other organ meats. That is why you should limit your intake. (iv) Sodium: Aim for less than 2,300mg of sodium a day. High sodium is highly not recommended as it can increase your risk for high blood pressure and other diseases.
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(b)
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Therapeutic Diet for High Blood Pressure (HBP) Now let us look at HBP. High blood pressure or hypertension, is a disease. Even though it typically has no symptoms, HBP can have deadly health consequences if not treated accordingly. Eating a heart-healthy diet is very important for managing your blood pressure and reducing risk of heart attack, heart disease, stroke and other diseases. American Heart Association has suggested using Dietary Approaches to Stop Hypertension (DASH) diet (it is a lifelong diet approach to healthy eating habit that encourages or helps in preventing high blood pressure). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure such as potassium, calcium and magnesium (Mayo Clinic, 2015). What does DASH diet consist of? What to eat according to this diet? To stay healthy, you need to follow the recommended diet to prevent diseases (refer to Table 4.5). Table 4.5: Food to Consume to Prevent Diseases Food
Description
Six to eight servings a day.
Bread, cereal, rice and pasta.
Four to five servings a day.
Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fibre, vitamins and such minerals like potassium and magnesium.
Fruits
Four to five servings a day.
Dairy
Two to three servings a day.
Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein.
Choose dairy products that are low-fat.
Six or fewer servings a day.
Meat can be a rich source of protein, vitamin B, iron and zinc.
Grains
Vegetables
Lean meat, poultry and fish
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Nuts, seeds and legumes
Fats and oils
Sweets
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Four to five servings a week.
Almonds, sunflower seeds, kidney beans, peas, lentils and other foods in this family are good sources of magnesium, potassium and protein.
Two to three servings a day.
Fat helps your body absorb essential vitamins and helps your body's immune system.
However, too much fat can increase your risk of heart disease, diabetes and obesity.
Five or fewer sweets a week.
When you eat sweets, choose those that are fat-free or low-fat such as sorbets, fruit ices, jelly beans, hard candy or low-fat cookies. Source: Mayo Clinic (2013)
Here is an important thing to remember: Drinking too much alcohol can increase blood pressure. The DASH diet recommends that men limit alcohol to two or fewer drinks a day and women one or less. However, the DASH diet does not address caffeine consumption. The influence of caffeine on blood pressure remains unclear. But caffeine can cause your blood pressure to rise at least temporarily. (c)
Therapeutic Diet for Renal Problem If you had been diagnosed with renal problem like chronic kidney disease, you may need to alter your diet. These changes include: (i)
Limiting fluids.
(ii)
Eating a low-protein diet.
(iii) Limiting salt, potassium, phosphorous and other electrolytes. (iv) Getting enough calories if you are losing weight. This diet is to keep the levels of electrolytes, minerals and fluid in your body balanced especially when you have chronic kidney disease or are on dialysis. People on dialysis need to follow this special diet to limit the build-up of waste products in the body. Limiting fluids between dialysis treatments is very important because most people on dialysis urinate very little due to the malfunction of their kidneys. Without urination, fluid will Copyright © Open University Malaysia (OUM)
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build up in the body and cause too much fluid in the heart, lungs and ankles and could cause other complications.
SELF-CHECK 4.2 Differentiate between healthy diet and therapeutic diet.
ACTIVITY 4.6 1.
Recommend an appropriate diet for high blood pressure patients.
2.
Plan a proper diet for diabetic patients.
3.
Discuss the advantages of organic food compared to normal food.
4.
Explain the potential benefits of genetically modified foods to society.
Food is much more than a tool of survival.
Components of healthy diet are protein, carbohydrates, fat, vitamins, minerals and water.
People of different age groups will need different types of food. Special population groups include children and teenagers, college students, older adults, athletes and pregnant women.
Healthy eating is about feeling great, having more energy, improving your outlook and stabilising your mood.
A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients.
A therapeutic diet is a modification of a regular diet. It is modified or tailored to fit the nutritional needs of individuals.
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Diabetes is a chronic disorder characterised by high blood glucose and either insufficient or ineffective insulin and depending on the type of diabetes.
American Heart Association has suggested using DASH diet as it is a lifelong diet approach to healthy eating habit that encourages or helps in preventing high blood pressure.
It is important to keep the levels of electrolytes, minerals and fluid in your body balanced when you have chronic kidney disease or are on dialysis.
Amino acids
High-density lipoproteins (HDL)
Antioxidants
Lipids
Carbohydrates
Low-density lipoprotein (LDL)
Coenzymes
Minerals
Diabetes
Protein
Dietary challenges
Renal problem
Fats
Therapeutic diet
Glucose
Vitamins
Healthy diet
Water
High blood pressure (HBP)
Better Health Channel. (2015). Water: A vital nutrient. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Water_a_ vital_nutrient/$File/Water_a_vital_nutrient.pdf Blakely, T. (2013). A fat week: Debates about saturated fat that will not go away. Retrieved from http://blogs.otago.ac.nz/pubhealthexpert/2013/10/29/afat-week-debates-about-saturated-fat-that-will-not-go-away/
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Carruthers, F. (2006). The facts about vitamins and minerals. Retrieved from http://www.healthyfood.co.nz/articles/2006/december/the-facts-aboutvitamins-and-minerals IHSS Training Academy. (n.d.). Types of therapeutic diets. Retrieved from http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/9%20Food%20N utrition%20and%20Preparation/Types_of_Therapeutic_Diets.pdf Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA: McGraw-Hill. Mayo Clinic. (2013). DASH diet: Healthy eating to lower your blood pressure. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/nutritionand-healthy-eating/in-depth/dash-diet/art-20048456 Mayo Clinic. (2015). Sample menus for the DASH diet. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthyeating/in-depth/dash-diet/art-20047110?pg=1 National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia. (2010). Malaysian dietary guidelines. Retrieved from http://dg.cnsoc.org/upload/affix/20140818104029708.pdf Robinson, L., Segal, J., & Segal, R. (2015). Healthy eating. Retrieved from http://www.helpguide.org/articles/healthy-eating/healthy-eating.htm Whitney, E. N., & Rolfes, S. R. (2002). Understanding nutrition (9th ed.). Victoria, Australia: Wadsworth Thomson Learning. Williams, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health, fitness and sport (10th ed.). New York, NY: McGraw-Hill.
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Topic
5
Maintaining Weight
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Explain the concept of weight management;
2.
Identify the causes of obesity;
3.
Differentiate the two types of eating disorders; and
4.
Plan weight management techniques.
INTRODUCTION Are you happy with your weight? Do you weigh yourself every morning and feel dissatisfied? How do you feel when you look at the scale? Hopefully, you do not hurt the scale, unlike the cartoon in Figure 5.1!
Figure 5.1: „Occupational hazard‰ for scale Copyright © Open University Malaysia (OUM)
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Do you agree that most people think they should weigh more or less than they do? Why do they think this way? Well, the primary reason for this is usually their appearance! Our appearances have a very strong link to our weight. For instance, the size of your clothing. Just think of your clothing size when you were 20. Is it the same as your current size? If the answer is no, then there are two possibilities, either that you have sized down or sized up. If you have sized down, yeay! Hurray for you! But if you have sized up, then you need to ponder on your diet and physical activities. Most of us have our own image or perception of how we would like to look, particularly if it concerns our body weight. Sometimes we need to change the way we look to ensure we achieve the image that we intend to have. Changes may be needed to achieve an ideal body weight especially to attain a new appearance. OneÊs physical appearance may improve oneÊs self-esteem. Therefore, in this topic, we will be discussing a few aspects related to maintaining weight. We are sure you agree that losing weight is not an easy task. If you fail to maintain your ideal weight, you will regain the lost weight. In order to ensure you understand the concept of weight maintenance, we will look at the basic components of weight management. Enjoy your lessons!
5.1
BASIC CONCEPTS OF WEIGHT MANAGEMENT
This first subtopic discusses two basic concepts of weight management. It is hoped that by the end of this subtopic, you can discuss weight management with your family and friends. The two basic concepts of weight management are body mass index (BMI) and body composition. How do we differentiate them? Let us find out the answers in the following subtopics.
5.1.1
Body Mass Index (BMI)
What is body mass index (BMI)? What does it stand for? Body mass index is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. WHO (2015)
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How do we calculate BMI? It is calculated using the formula of a personÊs weight in kilograms divided by the square of his or her height in meters (kg/m2) (WHO, 2015). Figure 5.2 shows you the formula to calculate BMI.
Figure 5.2: How to calculate body mass index (BMI) Source: http://www.the-health-magazine.com
Nowadays, there are a lot of computer applications and websites that can perform the calculation for you. You can try one at this website http://goo.gl/zURa85. Take note that calculating BMI for children and teens is more complex than for adults as it includes both gender and age (Insel & Roth, 2008). Did you know that BMI is used as a screening tool to identify weight problems in children? The Centers for Disease Control and Prevention (CDC) (2015) has developed BMI age growth charts for girls and boys which can be consulted to provide a percentile for a childÊs or teenÊs gender and age (Williams, Anderson & Rawson, 2013). This is shown in Figure 5.3.
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Figure 5.3: BMI percentile for children and teens by the Centers for Disease Control and Prevention Source: http://nccd.cdc.gov
BMI does not reveal anything about body composition. Therefore, we need another method to evaluate actual body composition. This will be explained in the next subtopic.
5.1.2
Body Composition
What is body composition? Body composition is what makes up a human body. The human body is divided into fat-free mass and body mass (fat). Fat-free mass includes non-fat tissues like bone, muscle, water, connective tissue, organ tissues and teeth while body fat includes fats that are incorporated in the nerves, brain, heart, lungs, liver and mammary glands. How do we calculate body composition? We can do this using a body composition analysis. Body composition analysis is a physical test that measures the proportion of the various components of a personÊs body. Copyright © Open University Malaysia (OUM)
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In other words, it is an important procedure in determining your body fat percentage. The most common form of body composition analysis is the BMI. Body composition can be changed to improve the way you look and feel by maintaining a healthy diet. However, we are not going to further explore the details of body composition in this topic. If you need further information on it, you can surf the Internet and read up on it. But, keep in mind that the most important fact you should know are the factors that contribute to excess body fat. Most of us claim that we follow a proper diet but still gain weight. Why is that so? This is because of our body weight and body compositions are determined by multiple factors that may vary from individual to individual. Those factors can be grouped into genetic, physiological, lifestyle and psychosocial. These four factors are further explained in the following Table 5.1. Table 5.1: Four Factors that Contribute to Excess Body Fat Factor
Description
Genetic
Genes influence body size and shape, body fat distribution and metabolic rate. The genes that you inherit from your parents may influence your body weight but the lifestyle you adopt can change that! That is the fact that you need to remember.
Physiological
These factors include metabolism, hormones, fat cells and carbohydrates craving. Change in diet can change these factors from bad to good.
Lifestyle
Eating and physical activities influence our body weight. Majority of overweight adults and children will admit they are overeating, consume high-fat, high-sugar and high-calorie foods. In addition, modern high technological conveniences such as remote controls, elevators and escalators have reduced some of our daily physical activities. To make things even worse, most of us have sedentary lifestyles. These sedentary lifestyles have led to increased body weight.
Psychosocial
Food is a very powerful tool to overcome negative emotions and stress. Some people try to distract themselves from their problems by eating. In some cultures, food has been used as a symbol of love and care. It has also become part of celebration in some culture.
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You can visit the listed websites for more explanation on these factors: (a)
Research Chair in Obesity at http://goo.gl/nqq9wz
(b)
Harvard Health Publications at http://goo.gl/5gYwlJ
SELF-CHECK 5.1 Form a group of three or four people in your tutorial class and discuss the factors that contribute to excess body fat.
5.2
OBESITY
Now let us look at obesity. It is hoped that by the end of this subtopic, you will be able to identify the causes of obesity. Did you realise that healthy eating is currently a growing concern in many countries? This is due to the rise in overweight and obesity rates worldwide (see Figure 5.4).
Figure 5.4: Overweight and obesity rates worldwide Source: http://www.nbcnews.com Copyright © Open University Malaysia (OUM)
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Overweight and obesity has changed the way we view nutrition. Nutrition transition is a term that refers to the change in diet structure, sedentary lifestyles and rapid increase in obesity rate (Ismawati, Zainalabidin & Golnaz, 2014; Wan Nazaimoon et al., 2011). Based on WHO report in 2010, Malaysia has been rated as the sixth country with the highest obesity rate in Southeast Asia (Ministry of Health Malaysia, 2010). Are we going to „keep‰ this record? Of course not! That is why we need to have a healthy lifestyle. What is overweight and obesity? World Health Organization (2015) defines a BMI greater than or equal to 25 as overweight and a BMI greater than or equal to 30 as obesity. This is illustrated in Figure 5.5.
Figure 5.5: Body mass index (BMI) for overweight and obesity
Keep in mind that being obese or overweight is not about aesthetics, but more on being at greater risk of health problems. Some of the health problems related to weight issues are explained in Table 5.2.
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Table 5.2: Health Problems Related to Obesity Health Problem Heart diseases
Description As your BMI increases, so does the risk for heart problems. This problem happens when plaque builds up in your coronary arteries or arteries that supply your heart muscles with blood and reduces the blood flow to the heart muscle. Plaque that accumulates on the inner walls of your arteries is made from various substances that circulate in your blood. These include calcium, fat, cholesterol, cellular waste, and fibrin, a material involved in blood clotting. As plaque deposits grow, it results in a condition called atherosclerosis. This condition causes the arteries to narrow and harden. If you are overweight, you may develop hypertension, diabetes and atherosclerosis. These conditions will put you at high risk of cardiovascular disease. Obesity can lead to a condition where your heart may not be able to pump enough blood to meet your bodyÊs needs.
High blood pressure
Blood pressure is the force of blood pushing against the walls of arteries. If the pressure rises for a long period of time, it can damage our body in many ways. The chance is higher if you are obese.
Stroke
When you are overweight or obese, plaque can easily build in arteries. If the area of plaque ruptures, blood clot might form and this condition can cause blockage of blood and oxygen flow to the brain. The risk of stroke is higher if your BMI is higher.
Diabetes (type 2)
Diabetes in simple words means high level of glucose in our blood. For type 2 diabetes, your bodyÊs cells fail to use insulin properly. Overweight people are more likely to develop type 2 diabetes if they fail to reduce their weight.
You can visit this website for more information about health problems related to obesity at http://goo.gl/T16QGR.
ACTIVITY 5.1 1.
Discuss the barriers to healthy eating that lead to obesity among Malaysians.
2.
Highlight actions to solve the above issue.
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EATING DISORDERS
Let us turn our attention to eating disorders. We hope that by the end of this subtopic, you will be able to differentiate the two types of eating disorders (see Figure 5.6). Firstly, let us look at the definition of eating disorder. Eating disorders can be defined as serious conditions related to persistent eating behaviours that negatively impact your health, emotions and ability to function.
Figure 5.6: Two types of eating disorders
As shown in Figure 5.6, there are two extreme conditions of eating habits that lead to eating disorder. First, someone who consumes too much food and loves eating is at risk of obesity. This disorder is known as bulimia nervosa. Second, someone who refuses to eat is at risk of an extreme condition known as anorexia nervosa. Teenagers and young women are those groups of people who mostly experience eating disorders. Why are these eating disorders dangerous for our health? We will look at each of these disorders closely in the next subtopic.
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5.3.1
MAINTAINING WEIGHT
Anorexia Nervosa
How do we define anorexia nervosa? Well, here is a definition for you to understand the meaning of anorexia nervosa. Anorexia nervosa is a complex disorder that has three important features, namely, refusal to maintain ideal and healthy body, fear of gaining weight and a distorted body image.
Figure 5.7 shows you how people with anorexia nervosa look like.
Figure 5.7: Images of people with anorexia nervosa Source: www.freakingnews.com
You can visit this YouTube link for better understanding on this problem at https://goo.gl/W2AycE. For those suffering from anorexia nervosa, life becomes a relentless pursuit of thinness; they are willing to go to extremes to lose weight, even though they are already skinny. Anorexia is not about food or weight but is much more complicated than that. A person who suffers from this condition can die if he or she does not seek proper treatment. Fortunately, recovery is possible if they want to change. Copyright © Open University Malaysia (OUM)
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There are two types of anorexia as stated in Table 5.3. Table 5.3: Two Types of Anorexia Nervosa Restricting
Purging
Weight loss is achieved by restricting calories.
Weight loss is achieved by vomiting or using laxatives and diuretics.
For example, following drastic diets, fasting and exercising to excess.
Now let us talk about the characteristics of anorexia nervosa. What are they? People with anorexia nervosa are typically introverted, emotionally reserved and socially insecure. In addition, their sense of self-esteem may be tied up entirely in their evaluation of their body shape and weight (Insel & Roth, 2008). What are the health risks if you have anorexia nervosa? Well, health consequences that can happen include the following: (a)
For women, they can stop menstruating because of extreme weight loss;
(b)
Intolerance of cold temperature;
(c)
Low blood pressure; and
(d)
Low heart rate.
Did you know that when body fat is virtually gone and muscles are severely wasted, our body will turn to its own organs in a desperate search for protein? That is why this may be the primary cause of death for anorexia nervosa patients. In addition, their desperation to look thin can be one of the reasons they commit suicide. So how do we overcome this problem? In order to ensure this serious illness is treated according to the nature of the disease, you must know how to tackle it. The first thing to do is to avert a medical crisis by ensuring adequate body weight, then counter this with psychological counselling.
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MAINTAINING WEIGHT
Bulimia Nervosa
Now let us look at bulimia nervosa. Bulimia nervosa is also a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge, eating large amounts of food and then purge, trying to get rid of the extra calories in an unhealthy way. For example, someone with bulimia nervosa may force herself to vomit or engage in excessive exercise (see Figure 5.8).
Figure 5.8: Vomiting food after eating is one of the characteristics of bulimia nervosa Source: http://amarhealth.com/2015/09/20/bulimia-nothing-unusual-good-for-health/
Sometimes, people purge after eating only a small snack or a normal-size meal. Have you heard of any famous celebrity who has this problem? Bulimia can be categorised in two types as explained in Table 5.4. Table 5.4: Two Types of Bulimia Nervosa Purging
Non-Purging
Regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.
Use other methods to get rid of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.
What do you think about the characteristics of a person with bulimia nervosa? A bulimic person on a binge will consume a lot of food and this is usually followed by purging, vomiting or using laxatives. They always appear to eat normally but in real situation, they do not feel happy when surrounded by food. A factor that may contribute to this problem is changes in life such as having a new baby, losing a job or stress. Copyright © Open University Malaysia (OUM)
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What are the health risks of this eating disorder? One of the risks is tooth decay. Tooth decay may develop because of the large consumption of sugar. In addition, repeated vomiting or the use of laxatives in combination with deficient calorie intake may damage liver and kidneys and can cause abnormal heart rhythm (cardiac arrhythmia). There are a lot more health consequences of bulimia nervosa which you can read more in any related websites. One example is from this website at http://goo.gl/K8dBXX. So how do we treat this disorder? A person suffering from bulimia nervosa needs to stabilise the eating pattern and improve their coping skills. For medical treatment, they need to get advice from qualified psychiatrists and nutritionists.
SELF-CHECK 5.2 Create a table that differentiates between anorexia nervosa and bulimia nervosa. Use „Definition‰, „Characteristics‰, „Health Risks‰ and „Treatment‰ as fields.
ACTIVITY 5.2 Imagine you are suffering from a eating disorder. What are the steps that you may take when you realise that your life is worth more than the problem you are having?
5.4
WEIGHT MANAGEMENT TECHNIQUES
Lastly, before we end this interesting topic, let us learn how to manage our weight. It is hoped that by the end of this subtopic, you will be able to plan your own weight management using appropriate techniques. What can we do to gain an ideal weight? Exercise? Limit what we eat? I know most of us would choose the second option but why do you need to suffer when you can enjoy your food by planning your diet. Just keep in mind that you must know how to ensure you get your ideal weight and stay healthy. In order to ensure these targets are achieved, you must learn weight management techniques.
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First of all, let us look at how we should adopt healthy lifestyles for successful weight management. (a)
Diet and Eating Habits Plan your diet and enjoy your food of choice. You can refer to any food pyramid to make a choice (see Figure 5.9).
Figure 5.9: Food pyramid Source: https://tiffanycodilla.wordpress.com/
Take note that you also need to pay attention to the total calorie in take and portion size so as to adjust eating habit to suit your requirement. (b)
Physical Activity and Exercise We are sure you agree that regular exercise is very important in weight management. In order to get an ideal weight, you need to burn the calories and keep the metabolism geared so that your body uses food for energy instead of storing it as a fat. There are many activities that you can try such as walking, gardening, housework, dancing or even Zumba. You can pick and select your own choice of activities to burn your calories.
(c)
Thinking and Emotions Did you realise that these two aspects are very important in weight management? This is because what goes in your head is the main influence that can change your thinking about your lifestyle in order for you to gain your ideal weight. Generally, most overweight people have low selfesteem. So, to change, you need to change your mindset; negative thoughts will stop you from making a start. Therefore, you need to think that you Copyright © Open University Malaysia (OUM)
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can do it as healthy lifestyle needs support from positive thinking, realistic beliefs and set goals to achieve your ideal weight. We here discussed some tips to ensure you are able to adopt proper techniques for weight management. Now let us look at how body image is important to help you feel good. The objective is to ensure that you are happy with your ideal weight and able to get rid of negative thoughts if your weight increases. What is the meaning of body image? Body image consists of perceptions, images, thoughts, attitudes and emotions of a person.
When you have an ideal body weight, immediately your image will change and you will be happy with your appearance. However, some of us have severe body image problems. This will cause significant psychological distress. Adolescents and adults who have negative body images are more likely to have restricted diet or other eating disorders. Generally, women are more concerned or dissatisfied with their body (Insel & Roth, 2008). How can you avoid body image problems? The following are some tips for those who plan to make changes: (a)
Focus on healthy diet and ensure you take proper exercise.
(b)
Ensure you have good psychological health because your worth as a human being is not based on your appearance.
(c)
You can influence your body size and determine your own lifestyle. You may want to accept your size.
(d)
Value and have respect for others.
(e)
Healthy eating habits is an important part of wellness.
(f)
Do not judge yourself or others based on appearance. Body size is just one characteristic; you need to keep in mind that being happy is more important.
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ACTIVITY 5.3 1.
2.
Discuss your strategies for weight management. Your strategies must include these components: (a)
Choice of food;
(b)
Planning and serving; and
(c)
Physical activities.
Let us say you have a friend suffering from a eating disorder. What is your plan to help your friend regain confidence and start a new chapter in his or her life?
There are two important concepts in weight management, which are body mass index and body composition.
Body mass index is a simple index of weight-for-height which is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his or her height in meters (kg/m2).
Body composition refers to fat-free mass and body mass (fat). Our body is divided into these two components. Fat-free mass includes non-fat tissues like bone, muscle, water, connective tissue, organ tissues and teeth, while body fat includes fats that incorporated in the nerves, brain, heart, lungs, liver and mammary glands.
There are four factors that contribute to excess body fat ă genetic, physiological, lifestyle and psychosocial factors.
Overweight happens when your BMI is greater than or equal to 25 and obesity happens when your BMI is greater than or equal to 30.
There are two types of eating disorders, namely, anorexia nervosa and bulimia nervosa.
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Anorexia nervosa is a complex disorder with the following three symptoms:
Refusal to maintain ideal and healthy body;
Fear of gaining weight; and
Distorted body image.
People with anorexia nervosa are typically introverted, emotionally reserved and socially insecure.
Bulimia nervosa is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge, eating large amounts of food and then purge, trying to get rid of the extra calories in an unhealthy way.
Weight management technique requires a person to adopt healthy lifestyles such as good eating habits, exercise and positive attitude.
Anorexia nervosa
Fat-free mass
Body composition
Obesity
Body image
Overweight
Body mass
Plaque
Body mass index (BMI)
Sedentary lifestyles
Bulimia nervosa
Weight management
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Centers for Disease Control and Prevention (CDC). (2015). Division of nutrition, physical activity and obesity. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/index.html Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA: McGraw-Hill. Ismawati, S., Zainalabidin, M., & Golnaz, R. (2014). Healthy eating: The preventive factors among Malaysians. Journal of Economics, Business and Management, 2(4), 257-261. Keyes, A. (2014). Infographic: Obesity skyrockets across the globe. Retrieved from http://www.nbcnews.com/nightly-news/infographic-obesity-skyrocketsacross-globe-n116996 Minsitry of Health Malaysia. (2010). Kenyataan akhbar Menteri Kesihatan Malaysia. Retrieved from http://www.moh.gov.my/index.php/database_stores/store_view_page/2 2/71 Wan Nazaimoon, W. M., Kamarul Imran, M., Amir Sharifuddin, M. K., Aziz al-Safi, I., Ikram Shah, I., Khalid, A. K., Nor Azmi, K., ... Wan Mohamad, W. B. (2011). Prevalence of overweight and obesity among adults Malaysian: An update. Asia Pacific Journal of Clinical Nutrition, 20(1), 3541. William, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health, fitness and sport (10th ed.). New York, NY: McGraw-Hill. World Health Organization (WHO). (2015). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/
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6
Preventing Diseases
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Discuss the importance of disease prevention to promote health and wellness;
2.
Summarise the risk factors, signs and symptoms as well as prevention of cardiovascular disease;
3.
Elaborate on the types, risk factors, signs and symptoms as well as prevention of cancer;
4.
Discuss diabetes mellitus and its causes, classification, risk factors and prevention;
5.
Summarise the risk factors and prevention of osteoporosis; and
6.
Describe kidney disease and its causes, signs and symptoms, risk factors and prevention.
INTRODUCTION Let us start our lesson by looking at this famous quote:
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We are sure you are familiar with it. What does this quote imply? The implied message here is that promoting good habits to maintain health is a better option than seeking cure for an ailment. The implication of the message proposes that people who practise healthy habits as a way of life have a higher chance to enjoy freedom from disease as dependence on medications and treatments to maintain wellness is not a healthy way of living. Did you notice that presently, non-communicable diseases due to lifestyle choices is emerging as significant forms of disease patterns? People who do not practise healthy lifestyles will become more vulnerable to these diseases. Some examples of such disease conditions include coronary heart diseases, cancer, diabetes mellitus, osteoporosis and kidney disease. These five diseases are the focus of this topic. You will learn their definitions, risk factors, signs and symptoms as well as preventions. It is hoped that by the end of this topic, you can design your personal plan to improve your health and wellness as well as preventing these diseases.
6.1
IMPORTANCE OF DISEASE PREVENTION
Why do we need to learn the importance of disease prevention? Well, we need to learn about disease prevention as a means to promote health and wellness in ourselves. Therefore, this subtopic will deliver the points for you to remember. Did you know that since the beginning of the 20th century, life expectancy has improved dramatically worldwide especially in developed countries? Now, people are living longer with significantly improved quality of life and not succumbing easily to debilitating diseases. In Malaysia, the average life expectancy has risen dramatically in the last 50 years, from below 60 years during the Independence era to an average of 75 years today (MOH, 2015). The promotion of healthy lifestyles and prevention of diseases through lifestyle changes has greatly contributed in raising the health standards in this country. Empowering people with appropriate knowledge and skills to modify their lifestyles and to take active roles to prevent illnesses has become a compelling inducement for those who understand the benefits of staying healthy. In addition, most people now prefer to take an active role in decisions related to their health matters as they dread the prospect of being hooked to a lifetime of medications to cope with chronic illnesses.
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Furthermore, increasing awareness on the role of clean environment on health and wellness is also becoming a major concern among many people as they begin to realise the direct impact the environment has on their health. As a result, there is a rising trend among health conscious individuals to play more active roles in creating a clean and healthy environment that is conducive to general wellness. The United Nations (UN) and the World Health Organization (WHO) work closely with member countries to promote health and wellness of the community. The promotion of healthy behaviours by health authorities has effectively reduced the burden of preventable diseases and promoted better quality of life and sense of well-being among the population. For example, some of the deadly diseases like small pox and poliomyelitis is said to be totally eradicated now. With the effective control of dreaded infections and communicable diseases especially in countries with modern healthcare systems, chronic and non-communicable diseases due to lifestyle choices is now emerging as significant forms of disease patterns. As stated before, the rise in non-communicable diseases is attributed to lifestyle choices of people. People who do not practice healthy lifestyles will become more vulnerable to such non-communicable diseases which have long term effects on our body and are much more difficult to control. Did you know that most forms of non-communicable disease are also known as chronic disease? What are the examples of these conditions? Some examples of such disease conditions include coronary heart diseases (CHD), cancer, diabetes mellitus, osteoporosis and kidney disease. Coronary heart disease (CHD) is also known as coronary artery disease (CAD). You will learn more on these five diseases in the next subtopics. Hopefully you can understand that many of these diseases can be controlled and even prevented through lifestyle modifications. Let us now focus on some of the serious but common diseases prevalent in this country.
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ACTIVITY 6.1 1.
Differentiate between communicable diseases.
2.
Look up Health Facts 2014 published by the Malaysian Health Ministry at http://goo.gl/5mmFjx. Identify four examples of communicable diseases and five examples of non-communicable diseases.
3.
Briefly state the lifestyle habits that relate to the cause of each of the diseases you have identified in Question 2.
6.2
communicable
diseases
and
non-
CARDIOVASCULAR DISEASES
This subtopic focuses on cardiovascular diseases. Hopefully, you will be able to identify the common forms of heart disease that are linked to lifestyle choices upon completing this lesson. Firstly, what does cardiovascular disease mean? Cardiovascular diseases are a variety of ailments associated with malfunctioning within the heart as well as the blood circulation in the body.
The most serious cardiovascular diseases that are related to lifestyle choices are coronary heart diseases, heart failure, hypertension and stroke. There are some heart conditions caused by other factors such as rheumatic heart disease and valvular heart diseases due to infection and septal defects caused by congenital anomalies.
6.2.1
Understanding the Heart
What can we say to define the heart? The heart is a muscular organ about the size of your fist and is located at the centre of the chest, behind the sternal bone.
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The following Figure 6.1 shows you the location and diagram of the heart.
Figure 6.1: Human heart
It is an amazing fact that our heart pumps approximately 70 times a minute in an adult to circulate oxygenated blood to the cells of the body through a network of arteries and receives back deoxygenated blood through the veins. The arteries that supply oxygenated blood to the heartÊs own muscles are known as coronary arteries. Take note that there is a disease associated with coronary arteries. It is called coronary heart disease (CHD) which accounts for the most number of fatalities among cardiovascular diseases in adults. In other words, coronary artery disease leads to coronary heart disease. Therefore, we will learn about this disease so that you will be able to identify the common risk factors for coronary heart disease. Coronary Heart Disease What does CHD stand for? Coronary heart disease is a condition where the heartÊs blood supply is reduced or completely blocked by plaque which is formed due to build-up of fats or other deposits such as tar from cigarettes within the walls of the coronary arteries.
Did you know that the narrowing of the arteries due to the plaque is known as atherosclerosis? Take note that as the size of the plaque gradually gets bigger, the oxygenated blood supply reduces, causing damage to the cells of the heart muscle. During this event, a person will eventually experience a heart attack that manifests as chest pains. In medical terminology, a minor heart attack or transient chest pains is known as angina pectoris, whereas a full-blown heart attack is known as myocardial infarction.
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6.2.2
Risk Factors that Cause Coronary Heart Disease (CHD)
PREVENTING DISEASES
What are the factors that trigger a heart attack? Heart attacks can be triggered by: (a)
Smoking;
(b)
Diabetes mellitus;
(c)
Hypertension;
(d)
High blood cholesterol;
(e)
Obesity; and
(f)
Excessive and prolonged stress.
ACTIVITY 6.2 1.
Identify the dangers of smoking to health.
2.
Discuss the effects of obesity on your heart.
6.2.3
Seriousness of Coronary Heart Disease
Did you know that coronary heart disease is the main cause of death in Malaysia? This is based on the statistics from Malaysian Health Ministry (MOH, 2015) which shows that CHD was the number one cause of death, amounting to about 25% of all fatalities in hospitals in 2013. In fact, coronary heart disease also happens to be among the top five reasons for hospital admissions in Malaysia since the past decade. This trend is similar to other developed and major developing countries. For example, the Centres for Disease Control and Prevention (CDC) (2015) reports that about 610,000 people die of heart disease in the US every year ă that is one in every four deaths. As for the UK, about 1 in 6 men and 1 in 10 women die of CHD annually. The astonishing facts are a grim reminder of the serious threat that CHD poses on the health and wellness of people.
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ACTIVITY 6.3 1.
Refer to Health Facts 2014 published by the Ministry of Health Malaysia at http://goo.gl/5mmFjx. Identify the top five disease conditions that were the cause of hospital admissions in this country in 2013.
2.
Discuss how many of the diseases are caused by lifestyle factors.
6.2.4
Signs and Symptoms of Coronary Heart Disease
What are the signs and symptoms of cardiovascular diseases? For coronary artery disease, chest pain is the most common symptom experienced by a person. As for coronary heart disease, the victim may also experience some of the following signs and symptoms: (a)
Radiation of pain over left arm, neck, jaw, shoulder or stomach;
(b)
Tightness over chest;
(c)
Breathlessness;
(d)
Heart palpitations;
(e)
Excessive sweating;
(f)
Feeling lightheaded or fainting; and
(g)
Nausea.
Take note that not all victims of heart attacks experience the signs and symptoms mentioned above as a person may even develop a silent heart attack during sleep. Silent heart attacks are known to occur among people with diabetes.
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6.2.5
Preventing Coronary Heart Disease
PREVENTING DISEASES
How do we prevent CHD? This subtopic will provide the answers so that you are aware of the ways to prevent and reduce coronary heart disease risks. Lifestyle choices are linked to CHD. Some of the specific ways to prevent CHD are as follows: (a)
Keeping blood pressure under control;
(b)
Keeping blood sugar under control;
(c)
Managing stress;
(d)
Taking a healthy, well balanced diet;
(e)
Being physically active and regular exercise;
(f)
Maintaining a normal, healthy body weight;
(g)
Refraining from smoking, recreational drugs and alcohol;
(h)
Taking any prescribed medicines regularly; and
(i)
Having a positive outlook in life.
SELF-CHECK 6.1 1.
Define coronary heart disease (CHD).
2.
List all the factors that lead to a heart attack.
3.
Describe the signs and symptoms of coronary heart disease as well as its prevention.
ACTIVITY 6.4 Discuss the effects of smoking on the risk of coronary heart disease.
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UNDERSTANDING CANCER
Now let us learn about cancer. It is hoped that by the end of this subtopic, you would be able to appreciate that cancer is a disease condition that is linked to our lifestyle choices. Did you know that since the past 50 years, cancer has instilled great fear among people? This is due to likelihood of it being a fatal disease with almost no prospect of cure. In spite of major advances in medical science and technology, the disease continues to afflict people of all ages, gender, ethnic origins and socioeconomic status. Previously, cancer used to be a worry among older age groups, but now childhood cancers such as leukaemia and bone cancers are being reported with increasing frequency. The Health Ministry of Malaysia (MOH, 2015) reported 4,414 deaths due to cancer in the year of 2013, ranking as the fourth principal cause of death in hospitals of Malaysia.
6.3.1
What is Cancer?
Let us get to know the definition of cancer first. Do you have any idea? Cancer is a condition where cells in a specific part of the body begin to grow at an abnormal and uncontrollable rate.
This results in formation of tumours. What are tumours? Tumours are abnormal masses of tissue cells that have grown and multiplied rapidly.
These tumours can be benign or malignant. What are the differences between them? Let us check out Table 6.1 for the answer.
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Table 6.1: Benign Tumours versus Malignant Tumours Benign Tumours
Malignant Tumours
Non-life threatening growths which are localised ă they do not spread to other parts of the body.
Grow rapidly and spread from the original primary site, to form new secondary tumorous growths at other parts of the body through a process called metastasis.
However, they can become large and interfere with blood and lymphatic circulation or they may obstruct other body functions.
The cancer cells can infiltrate cells within their vicinity and destroy blood vessels, organs, nerves and lymphatic system. The severity of malignant tumours are often classified by the level of differentiation and advanced stage of cell growth.
Let us look at Figure 6.2 which shows you the difference between benign tumours and malignant tumours.
Figure 6.2: The difference between benign cells (not cancer) and malignant cells (cancer) Source: www.medicinenet.com
SELF-CHECK 6.2 Describe the difference between benign tumours and malignant tumours.
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Common Types of Cancer
Did you know that cancerous tumours are generally classified according to the type of tissue from which they originate? There are mainly four types of cancer as explained in Table 6.2. Table 6.2: Four Types of Cancer Type of Cancer
Description
Carcinomas
Originate in outer layers of body tissue called epithelial tissue.
Sarcomas
Develop mainly in fibrous and connective tissue of body.
Lymphomas
Develop and spread in the lymphatic system.
Leukaemia
Affect leucocytes which are a form of blood cells in the body.
Apart from these four, cancers are also specified by the organ in which they breed. Can you think of some examples? Well, the answers are lung cancer, breast cancer, prostate cancer, bowel cancer, brain cancer and others. Keep in mind that the diagnosis and treatments vary for each type of cancer.
6.3.3
Risk Factors for Cancer
This subtopic describes the common risk factors for cancer. It is hoped that by the end of this subtopic, you can identify the common risk factors for cancer. So, what are the risk factors for cancer? Experts believe that the causes of most types of cancers are multifactorial. Table 6.3 gives you the risk factors for cancer formation. Table 6.3: Risk Factors for Cancer Formation Risk Factor
Description
Lifestyle choices
Certain types of diet, smoking, stress and obesity can lead to cancer formation.
Environmental exposure to carcinogens
Asbestos, tobacco, alcohol, radiation, carbon emissions, petroleum by-products, toxic chemicals, certain dyes, food preservatives, ultraviolet light and others can contribute to cancer formation.
Viruses
Herpes II, hepatitis B, HIV and Epstein Barr viruses are linked with certain types of cancers.
Chronic irritation
Tobacco chewing leads to chronic irritation of the inner linings of the mouth.
Genetics
Presence of oncogenes that predispose to cancer growths.
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6.3.4
Signs and Symptoms of Cancer
PREVENTING DISEASES
First of all, you need to be alert with your body. Take note of sudden, unexplained changes to parts and normal processes of the body such as appearance of lumps or blood in the urine or faeces; they should be investigated for early signs of cancers. Other potential signs and symptoms of cancer include the following: (a)
Sudden unexplained weight loss;
(b)
Lumps in breasts or other body parts;
(c)
Bleeding in between menstrual periods, blood in the urine, cough or vomiting;
(d)
Chronic cough, persistent, dull, aching pain over a body part, mild fever and breathlessness;
(e)
Changes in bowel habits such as blood in the stools, diarrhoea or constipation for no apparent reason; and
(f)
Moles that are growing more than seven millimetres in diameter, irregular shape and size, itchy, crusting or bleeding.
SELF-CHECK 6.3 1.
Briefly explain five risk factors for cancer formation.
2.
Identify five abnormal changes in the body that may signal the onset of cancer.
6.3.5
Prevention Strategies for Cancer
Before we end our discussion on cancer, let us learn its prevention so that you can suggest approaches that we can take to prevent or reduce personal risks of cancer. What does prevention of cancer refer to? Prevention of cancer refers to recognition of potential cancer causing hazards and taking affirmative action to avoid prolonged exposure to carcinogens from the food source and other environmental hazards. Some of the specific prevention strategies are explained in Table 6.4.
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Table 6.4: Specific Prevention Strategies for Cancer Strategy Improving lifestyle behaviours
Description Vigilant about risk factors such as regular screening if history of cancer present among blood-linked family members and avoidance of over exposure to known pollutants as form of occupational hazard. Avoidance of toxic chemical and radioactive radiation exposure. Protection against excessive exposure to ultra violet light. Eating a balanced and healthy diet. Avoidance of alcohol and tobacco. Controlling excessive body weight. Regular exercise. Managing stress. Regular checking of body parts to detect sudden, abnormal changes, such as: ă C : Change in bowel or bladder habits; ă A : A sore that does not heal; ă U : Unusual bleeding or fluid discharge from the body; ă T : Thickening or lump in breasts or elsewhere; ă I : Indigestion that persist or difficulty in swallowing; ă O : Obvious change in a wart or mole; and ă N : Nagging cough or voice hoarseness.
Practising responsible consumerism
Although maintaining a healthy environment requires a collective effort within the larger community, a person can: ă Begin to exercise his or her right by observing good purchasing habits; ă Choose more „green‰ products; ă Choose organic food products; ă Avoid pollution; and ă Participate in responsible recreation.
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Becoming an active advocate for your health
PREVENTING DISEASES
Being aware of safer options when seeking for medical treatment; Awareness and avoidance of risk factors to yourself, family and community; Spreading consciousness about role of responsible citizenship within the community; and Exercising voting rights for governance of safe, environment and legislation of sound health policies.
6.4
healthy
UNDERSTANDING DIABETES MELLITUS
Now let us turn our attention to diabetes mellitus. I hope by reading this subtopic, you will be able to increase your awareness of diabetes mellitus as it is a chronic condition that is mainly linked to poor lifestyle choices. Do you know anyone around you who has diabetes mellitus? Chances are that you will easily recall someone you know who has diabetes mellitus. It has become one of the fastest growing disease conditions afflicting humans in the modern era. Why is it considered to be a very serious disease condition? Diabetes mellitus is a very serious disease condition as it leads to multiple body complications such as atherosclerosis, coronary heart disease, hypertension, infections, cataracts, blindness, chronic kidney disease, skin infections, gangrene and erectile dysfunctions.
6.4.1
Causes of Diabetes Mellitus
Before we look at the causes of diabetes mellitus, let us look at its definition. Typically, diabetes mellitus is an endocrine disorder perpetuated by irregularity of insulin production or its physiologic action in the body.
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What does insulin mean? Insulin is a hormone produced by the pancreas. Its function is to enable glucose (from carbohydrates metabolism) in the blood stream to enter into the body cells for energy production.
What happens if the insulin is insufficient? If there is insufficient insulin, glucose levels remain high in the blood stream, giving rise to hyperglycaemia. Likewise, reduced blood glucose levels or excessive levels of insulin in the blood stream will cause hypoglycaemia. Figure 6.3 shows you the different signs and symptoms for these two conditions of insufficient insulin.
Figure 6.3: Signs and symptoms of hyperglycaemia and hypoglycaemia Source: http://positivemed.com/2012/12/23/blood-sugars-high-or-low/
SELF-CHECK 6.4 Identify the causes as well as signs and symptoms for hyperglycaemia and hypoglycaemia.
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6.4.2
Classification of Diabetes Mellitus
PREVENTING DISEASES
Did you know that generally there are three types of diabetes mellitus? These are further explained in Table 6.5. Table 6.5: Three Types of Diabetes Mellitus Types of Diabetes Mellitus
Description
Type 1 diabetes mellitus
This is also known as insulin-dependent, juvenile onset diabetes.
Type 2 diabetes mellitus
This is non-insulin dependent diabetes, typically adult onset diabetes. It is the most common type of diabetes.
Gestational diabetes
Apart from the two main types, this is a transient type of diabetes which manifests in some women during the pregnancy period and resolves when pregnancy is over.
In our ongoing discussion about diabetes mellitus, we will focus on type 2 diabetes as the risk of its onset is commonly linked to poor lifestyle practices.
SELF-CHECK 6.5 State the major difference between type 1 and type 2 diabetes mellitus.
6.4.3
Risk Factors of Diabetes Mellitus
By reading this subtopic, it is hoped that you will be able to identify the common risk factors for diabetes mellitus. So, what are they? The risk factors for diabetes mellitus stem from a mix of neglect of healthy lifestyle choices and some elements of non-modifiable risk factors such as the following: (a)
Obesity and physical inactivity;
(b)
High fasting blood sugar levels;
(c)
Advancing age;
(d)
Genetic predisposition; and
(e)
Ethnicity. Copyright © Open University Malaysia (OUM)
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From these five factors, we can observe that obesity, physical inactivity and high blood sugar levels can be controlled and thus are classified under modifiable risk factors. Conversely, we note that advancing age, genetic predisposition and ethnicity are non-modifiable risk factors for diabetes mellitus.
ACTIVITY 6.5 Conduct an online search and prepare a brief explanation on how obesity can lead to diabetes mellitus.
6.4.4
Prevention of Diabetes Mellitus
Lastly, how do we prevent diabetes mellitus? This subtopic provides you with the answer so that you will be able to suggest approaches to prevent risk of this disease. As yet, diabetes is considered an incurable disease condition and medical interventions merely attempt to regulate blood sugar levels by various means to negate the effects of complications from diabetes to the body. Therefore, prevention of diabetes is a better option as there is no known cure; it is prudent to prevent diabetes from taking root. This can be done by recognition and control of its trigger factors which are in the form of modifiable and non-modifiable risk factors. Vigilance and conscious efforts to mitigate the latent risk factors are essential for the disease prevention. The following are important aspects of prevention in order to prevent onset of diabetes mellitus: (a)
Maintaining ideal body weight;
(b)
Engaging in a regular programme of aerobic fitness exercises;
(c)
Maintaining a normal level of blood glucose; and
(d)
Early recognition of the warning signs of diabetes.
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6.5
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OSTEOPOROSIS
Now let us learn about osteoporosis. It is hoped that by reading this, you should be able to link osteoporosis as a condition that is related to our lifestyle choices. What do you know about osteoporosis? What can you say about it? Osteoporosis is a condition in which the bones weaken and become fragile as a result of low mineral content usually due to progressive aging.
Gradual loss of mineral content, mainly calcium phosphate renders the bones to be at greater risk of fracture and delayed healing. Women are particularly at higher risks for osteoporosis soon after their body stops estrogen production at menopause. Figure 6.4 shows you how osteoporosis looks like.
Figure 6.4: Normal bone versus bone with osteoporosis Source: http://scienceblogs.com
6.5.1
Risk Factors for Osteoporosis
What are the risk factors for this disease? Let us continue our lesson so that you can identify the common risk factors for osteoporosis. Osteoporosis results from a combination of factors such as: (a)
Genetics;
(b)
Body frame size;
(c)
Gender;
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(d)
Race;
(e)
Advancing age;
(f)
Reduced peak bone mass;
(g)
Low estrogen and testosterone levels;
(h)
Physical inactivity;
(i)
Inadequate dietary calcium intake;
(j)
Smoking; and
(k)
Alcohol consumption.
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ACTIVITY 6.6 Conduct an online search on the typical lifestyle practices that increase the risk of osteoporosis. Share your findings during tutorial.
6.5.2
Prevention Strategies for Osteoporosis
Hopefully by the end of this subtopic, you can suggest approaches that we can take to prevent osteoporosis. Take note that an important aspect of prevention includes making the right lifestyle choices at the early stages to reduce the rate of bone mass loss in later years. Some of the strategies include the following: (a)
Increased physical activity;
(b)
Taking dietary calcium supplements as required;
(c)
Being wary of over exercising;
(d)
Controlling alcohol consumption; and
(e)
Quit smoking.
ACTIVITY 6.7 Identify five examples of local food products that contain high calcium content, suitable for people to avoid osteoporosis.
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KIDNEY DISEASE
Lastly, before we end this interesting topic, let us look at kidney disease. It is hoped that by learning this subtopic, you can relate kidney disease as a disease condition that is linked to our lifestyle choices. Did you know that kidney disease have become the most common cause of kidney failure that cause patients to undergo dialysis treatment, often for life? Statistics released by MOH (2015) quote kidney diseases as the eighth most common cause for hospital admissions in 2013, accounting for more than 5% of all hospitalisations in Malaysia. As human beings, we have a pair of kidneys in the abdominal cavity on either side of the spine, just above the waist (refer to Figure 6.5).
Figure 6.5: Kidney position Source: www.ehealthstar.com
What are the functions of kidneys? The kidneys perform several life-sustaining functions such as: (a)
Cleansing the blood by removing waste and excess fluids;
(b)
Maintaining the balance of salts and minerals in the blood;
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(c)
Helping to regulate blood pressure;
(d)
Producing a hormone named erythropoietin which stimulates red blood cell production; and
(e)
Producing a form of vitamin D which we need for bone health.
The sudden loss of kidney function is called acute kidney failure or acute kidney injury. It is mainly attributed to the following three effects that disrupt the functions of the kidneys: (a)
Lack of blood flow to the kidneys;
(b)
Direct damage to the kidney tissue; and
(c)
Blockage of urine flow from the kidneys.
Take note that kidney failure can be fatal, and requires urgent and intensive treatment.
6.6.1
Common Causes of Kidney Disease
What are the common causes of kidney disease? Some of the common factors that lead to kidney disease include: (a)
Traumatic injury to kidney tissue that leads to bleeding;
(b)
Severe, prolonged dehydration;
(c)
Damage to kidneys due to shock during severe sepsis;
(d)
Obstruction of urine flow due to prostate enlargement, strictures or renal calculi;
(e)
Damage from certain nephrotoxic drugs or poisons; and
(f)
Complications related to pregnancy such as eclampsia.
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6.6.2
Signs and Symptoms of Kidney Disease
PREVENTING DISEASES
Sometimes, failure of kidney function due to disease has a slow, insidious onset and does not show any overt symptoms. It is detected incidentally through routine laboratory tests done for other reasons. However, you can look at these obvious physical signs and symptoms: (a)
Decreased urine output;
(b)
Fluid retention causing swelling in the legs, ankle region and feet;
(c)
Drowsiness;
(d)
Shortness of breath;
(e)
Chronic fatigue;
(f)
Confusion;
(g)
Nausea;
(h)
Seizures or coma in severe cases; and
(i)
Chest pain or pressure.
6.6.3
Risk Factors for Kidney Disease
Did you know that diabetes and high blood pressure are two leading causes of kidney damage? This is because they cause insidious damage to the delicate blood vessels within the kidneys. The other risk factors include: (a)
Cardiovascular diseases;
(b)
Family history of kidney disease;
(c)
Infections; and
(d)
Nephrotoxic drugs and chemicals.
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Prevention of Kidney Disease
Lastly, let us learn how to prevent this disease so that you will be able to suggest approaches that we can take to prevent risk of kidney disease. As we have read in the earlier discussion, prevention strategies prove to be an effective approach to avert the risk factors through lifestyle modifications to control modifiable risk factors for kidney damage. Therefore, a person who is at risk of kidney damage should adhere to the following precautions: (a)
Make healthy lifestyle a priority;
(b)
Regular medical check-ups to screen for kidney damage;
(c)
Manage diabetes, hypertension or heart disease;
(d)
Take prescribed medicines regularly and accordingly on time;
(e)
Keep kidneys healthy by choosing to eat foods that are free from toxic chemicals, and increase the portion of fresh foods and green vegetables;
(f)
Maintain adequate hydration of the body with clear fluids;
(g)
Control salt, potassium-rich foods and sugar intake in the diet;
(h)
Limit alcohol consumption;
(i)
Be physically active;
(j)
Keep weight at ideal levels;
(k)
Keep cholesterol levels within normal range; and
(l)
Quit smoking.
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ACTIVITY 6.8 Complete the following personal health risk assessment: Type 2 Diabetes Risk Assessment Circle the right answer and add up the points. Compare your final score with the risk of developing diabetes mellitus. Question
Point
Age Less than 35 years 35 to 44 years 45 to 54 years
0 1 2
55 to 64 years Above 64 years Body mass index (BMI)
3 4
Below 25kg/m2 25 to 30 kg/m2 Above 30 kg/m2
0 1 3
Waist circumference measured at level of belly button (navel) For men
Less than 94cm
0
94 to 102cm More than 102cm For women
3 4
Less than 80cm
0
80 to 88cm
3
More than 88cm
4
Question Point How often do you eat vegetables or fresh fruits? Everyday 0 Not everyday 1 Have you ever taken medication for high blood pressure on regular basis? No 0 Yes 2 Have you ever been found to have high blood glucose (such as in health screening test, during illness) No 0 Yes 5 Have any of your immediate family members or close relatives been diagnosed with diabetes? No 0 Yes, grandparent, aunty, uncle or 1st cousin Yes, parent, brother, sister or own child Total risk score
3
5
Interpretation of personal score Lower than 7 Low risk to develop diabetes 7 to 11 Slightly elevated risk 12 to 14 Moderate risk 15 to 20 High risk Higher than 20 Very risk
Do you usually have at least 30 minutes of vigorous physical activity or exercise daily, excluding normal daily activities? Yes 0 No 2
Source: http://www.diabetes.fi Copyright © Open University Malaysia (OUM)
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Advice to Lower Your Risk of Developing Type 2 Diabetes You cannot do anything about your age or your genetic predisposition. On the other hand, the rest of the factors predisposing to diabetes, such as overweight, abdominal obesity, sedentary lifestyle, eating habits and smoking, are up to you. Your lifestyle choices can completely prevent type 2 diabetes or at least delay its onset until a much greater age. If there is diabetes in your family, you should be careful not to put on weight over the years. Growth of the waistline, in particular, increases the risk of diabetes, whereas regular moderate physical activity will lower the risk. You should also pay attention to your diet; take care to eat plenty of fibre-rich cereal products and vegetables every day. Omit excess hard fat from your diet and favour soft vegetable fats. Early stages of type 2 diabetes seldom cause any symptoms. If you scored 12ă14 points in the risk assessment, you would be well advised to seriously consider your physical activity and eating habits and pay attention to your weight, to prevent yourself from developing diabetes. Please contact a public-health nurse or your own doctor for further guidance and tests. If you scored 15 points or more in the risk assessment, you should have your blood glucose measured (both fasting value and value after a dose of glucose or a meal) to determine if you have diabetes without symptoms. Source: http://www.diabetes.fi
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Assessing Your Risk for Osteoporosis For each of the following questions, check either yes or no. 1.
3.
5.
7.
9.
Do you have a family history of osteoporosis? (Have any of your female relatives broken a wrist or hip or had a dowagerÊs lump?) Yes No Did your menstrual periods ever stop for more than a year for reasons other than pregnancy or nursing? Yes No Have you had surgery in which a part of your stomach or intestines was removed? Yes No Do you have a thyroid or parathyroid disorder (hyperthyroidism or hyperparathyroidism)? Yes No Do you smoke cigarettes?
2.
4.
6.
8.
Yes No 11. Do you do less than one hour of exercising such as aerobics, walking or jogging per week? Yes No 13. Have you ever had an eating disorder (bulimia or anorexia nervosa)? Yes No
Did you go through menopause or have your ovaries removed by surgery before age 50? Yes No Did your ancestor come from England, Ireland, Scotland, Northern Europe or Asia or do you have a small, thin body frame? Yes No Are you taking or have you taken drugs like cortisone, steroids or anticonvulsants over a prolonged period? Yes No Are you allergic to milk products or are you lactose intolerant?
Yes No 10. Do you drink wine, beer or other alcoholic beverages daily? Yes No 12. Have you ever exercised so strenuously that you had irregular periods or no periods at all? Yes No
How did you do? Did you have several yes answers? If so, you may have a very high chance of getting osteoporosis. It would be a good idea to talk with your doctor today so that you can work together to keep this disabling disease from happening to you. Source: Donatelle, Snow & Wilcox (1999)
Based on your personal scores levels on each of the above scales, prepare an action plan for healthy lifestyle activity for yourself.
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The promotion of healthy lifestyles and prevention of diseases through lifestyle changes has greatly contributed to improving the health standards of people in this country.
Empowering people with appropriate knowledge and skills to modify their lifestyles and take active roles to prevent illnesses have become a compelling inducement for those who understand the benefits of staying healthy.
Most non-communicable diseases such as coronary heart diseases, cancer, diabetes mellitus, osteoporosis and kidney disease are attributed to lifestyle choices.
People who do not practise healthy lifestyles will become more vulnerable to non-communicable diseases which have long term effects on the body and are difficult to control.
Cardiovascular diseases consist of a variety of ailments associated with malfunctioning within the heart as well as the blood circulation in the body. The most serious cardiovascular diseases that are related to lifestyle choices are coronary heart diseases, heart failure, hypertension and stroke.
Common risk factors for coronary heart disease include smoking, uncontrolled diabetes mellitus, uncontrolled hypertension, high blood cholesterol, obesity, and excessive and prolonged stress.
Chest pain is the most common symptom experienced by a person with coronary artery disease. As for coronary heart disease, some of the signs and symptoms are nausea, breathlessness, excessive sweating and others.
Some of the ways risk of CHD can be mitigated are managing stress, keeping blood sugar and blood pressure under control and many more.
Cancer is a condition where cells in a specific part of the body begin to grow at an abnormal and uncontrollable rate. They are four types of cancer namely carcinomas, sarcomas, lymphomas and leukaemia.
Common risk factors for cancer include poor lifestyle choices, environmental exposure to carcinogens, exposure to viruses linked to certain types of cancers, chronic irritation and genetic predisposition to cancer.
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Some of the signs and symptoms of cancer are sudden unexplained weight loss, lumps in breasts or other body parts, moles that grow more than seven millimetres in diameter and others.
General prevention of cancer refers to recognition of potential cancer causing hazards and taking affirmative action to avoid prolonged exposure to carcinogens from the food source and other environmental hazards.
Diabetes mellitus is an endocrine disorder perpetuated by irregularity of insulin production or its physiologic action in the body. It can be divided into three types ă type 1, type 2 and gestational diabetes.
Common risk factors for diabetes mellitus include obesity and physical inactivity, high fasting blood sugar levels, advancing age, genetic predisposition and ethnic predisposition.
General prevention for diabetes mellitus is recognition and control of its trigger factors which are in the form of modifiable and non-modifiable risk factors. For example, maintaining ideal body weight and normal level of blood glucose, exercise and early detection.
Osteoporosis is a condition in which the bones weaken and become fragile as a result of low mineral contents usually due to progressive aging.
Common risk factors for osteoporosis include genetic predisposition, gender, race, advancing age, reduced peak bone mass, low estrogen and testosterone levels, physical inactivity, inadequate dietary calcium intake, smoking and alcohol consumption.
An important aspect of prevention of osteoporosis includes making the right choice of lifestyle at early stages which can reduce the rate of bone mass loss in later years. The right choice of lifestyle can be in terms of physical activity increment, taking calcium supplements and quit smoking.
Acute kidney failure results in the inability of the kidneys to filter the waste matter in the blood, which leads to rapid deterioration in health of the victim.
Common causes of kidney disease are traumatic injury to kidney tissue, severe and prolonged dehydration, eclampsia during pregnancy and others.
Some of the signs and symptoms of kidney disease are decreased urine output, drowsiness, confusion, nausea, chronic fatigue and others.
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Common risk factors for kidney disease include coexisting cardiovascular diseases, family history of kidney disease, infections, exposure to nephrotoxic drugs and chemicals.
Some of the preventions for kidney disease are healthy lifestyles, regular medical check-ups, be physically active, have an ideal weight, quit smoking and others.
Acute kidney failure
Leukaemia
Cancer
Lymphomas
Carcinomas
Non-communicable diseases
Coronary artery disease (CAD)
Osteoporosis
Coronary heart disease (CHD)
Preventions
Diabetes mellitus
Risk factors
Disease prevention
Sarcomas
Gestational diabetes
Signs and symptoms
Healthy lifestyles
Stroke
Heart failure
Type 1 diabetes mellitus
Hypertension
Type 2 diabetes mellitus
Ideal body weight
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Centres for Disease Control and Prevention (CDC). (2015). Heart disease facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and fitness (2nd ed.). Belmont, CA: Wadsworth. Finnish Diabetes Association. (2003). Programme for the prevention of type 2 diabetes in Finland. Retrieved from http://www.diabetes.fi/files/1108/Programme_for_the_Prevention_of_Ty pe_2_Diabetes_in_Finland_2003-2010.pdf Ministry of Health Malaysia (MOH). (2014). Health facts 2014. Retrieved from http://goo.gl/5mmFjx NHS Choices. (2013). Cancer information and useful links. Retrieved from http://www.nhs.uk/conditions/Cancer/Pages/Introduction.aspx NHS Choices. (2014). Osteoporosis. Retrieved from http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx Palevsky, P. M. (2015). Definition of acute kidney injury (acute renal failure). Retrieved from http://www.uptodate.com/contents/definition-of-acutekidney-injury-acute-renal-failure Pruss-Ustun, A., & Corvalan, C. (2006). Preventing disease through health
environment: Towards an estimate of the environmental burden of disease. Geneva, Switzerland: WHO Press.
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Topic
7
Financial Health and Wellness
LEARNING OUTCOMES By the end of this topic, you should be able to: 1.
Differentiate between financial health and financial wellness;
2.
Identify the challenges confronting „emerging‰ adults in their quest for financial wellness;
3.
Discuss the elements of financial wellness; and
4.
Construct a financial fitness plan.
INTRODUCTION As discussed in the previous Topic 3, financial health and wellness is one of the eight dimensions of the holistic model of health and wellness. Can you still recall? Take note that each of the eight dimensions has to be pursued individually but in tandem with the pursuit of the other seven dimensions. What are you going to learn in this topic? Basically, this topic is organised into four subtopics. In subtopic 7.1, we will be introduced to financial health and financial wellness. It also discusses the importance of financial wellness in the context of oneÊs total health. Then in subtopic 7.2, we will discuss the challenges to the attainment of financial wellness particularly during oneÊs passage to adulthood. Knowledge of past challenges (which had been experienced by past generations) will enable one to be better prepared to circumvent them as one travels through glitches in life.
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This is followed by subtopic 7.3 which discusses the elements of financial wellness that would be of help as one strives to attain wellness. Lastly, the final subtopic concludes with the concept of financial fitness, which is in vogue among major corporations around the world to help defray the cost of attainment of health and wellness to the corporations and their respective constituents alike. Hopefully, by the end of this topic, you will be able to construct a financial fitness plan that suits you. All the best!
7.1
FINANCIAL HEALTH AND WELLNESS
This first subtopic explains financial health and financial wellness. Hopefully, by the end of this subtopic, you will be able to differentiate between the two. Now, let us look at the definition of financial health first. Do you have any idea what it means? Financial health is a term used to denote „the state of oneÊs personal financial situation‰.
Take note that there are many dimensions of financial health, for example, disposable income, savings and loan repayments. In addition, the concept is embedded in the practices of organisations. How do we determine the financial health of business organisations? Financial health of business organisations is determined by examining their: (a)
Financial conditions (what the firm has) such as assets;
(b)
Liabilities (what the firm owes); and
(c)
Net worth (net amount of what the firm has after taking into consideration the claim of lenders on what the firm has).
Apart from knowing the absolute amount of each item, it is also important to know its relative composition. However, these items showed their respective position at one point in time. Other important aspects to consider are dimensions which show potential improvements or otherwise, of these items over time. This dimension is essentially pictured by the profitability of the firm. This is because profitability is an important determinant of the firmÊs future finances or its wellness.
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How about financial health of individuals? Similarly, it is a description of how well one deals with his or her finances, like making timely payments and setting aside a certain amount for savings. Now let us move on to financial wellness. Financial wellness of individuals, on the other hand, is a more holistic description. It denotes „the state of psychological well-being in which one feels they have control over their respective current finances as well as future finances.‰ Did you know that financial wellness is a new concept that came as an aftermath of the global Great Recession of 2008 to 2009? The turmoil of the Great Recession left many feeling vulnerable. Many people were ill-prepared to handle the experience of personal financial crisis that ensued. The two years of the Great Recession was not the only cause of the personal financial crisis. The effect of the recession on individuals was compounded by the widespread lack of appreciation of the basic underlying principles of good personal finance practices. As a consequence, poor financial results were experienced. What are the impacts of the poor financial state? The impacts of the poor financial state that resulted were compounded by widespread job losses, declining asset values and great drops in value of savings. These adverse phenomena left many in a state of financial distress. What does financial distress mean? Financial distress is a term in corporate finance which describes a situation where a company fails to honour its promises to pay its creditors according to the agreed term of credit.
What happens if financial distress cannot be relieved? If financial distress cannot be relieved, it may lead to bankruptcy. Consequentially, the concept of financial well-being came about as an important dimension of health and wellness. Generally, financial wellness is a state of financial affairs where an individual has achieved the following: (a)
Strong financial foundation with little or no debt, with some emergency savings fund and surplus income over expenditure;
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(b)
An ongoing plan that puts one on track to reach future financial goals; and
(c)
Absence of financial stress.
ACTIVITY 7.1 Go to University of Wisconsin-River FallsÊs website and take the wellness assessment test at https://goo.gl/rPHR1s. Answer each question honestly and reflect whether you could have been better off if each of the said practice has been observed fully.
7.1.2
Importance of Financial Wellness in the Context of One’s Total Health
Lien (2012), in introducing his Primal Finance Series, employed MaslowÊs hierarchy of needs to illustrate the building block of personal financial fulfilment and happiness. Following Maslow, Lien felt that it is hard for one to achieve professional success if he or she is devoid of „a meaningful place to live in, clothes to wear or food to consume. Fulfilling basic needs are mostly required before trying to satisfy higher order desires.‰ Lien thus laid the basic foundation of his series on MaslowÊs hierarchy of needs. For our purpose, it makes sense to use it as building blocks for reaching personal financial wellness. Let us review MaslowÊs hierarchy of needs shown in Figure 7.1.
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Figure 7.1: MaslowÊs hierarchy of needs Source: https://jimlien.files.wordpress.com
MaslowÊs hierarchy of needs is a psychological model based on analysing human needs and trying to fulfil them in a pecking order. Overall, the pecking order of needs is described in Table 7.1; it starts from basic to the most advanced.
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Table 7.1: MaslowÊs Hierarchy of Needs Level
Type of Needs
1 (most basic needs)
Specific Needs
Physiological
Breathing, food, water, sex, sleep, homeostasis and excretion. Not unsurprisingly, these are health related issues. Why would you try to attain something higher than health if you have none to enjoy?
2
Safety
The security of body, employment, resources, morality, family, health and property. Much of these have to do with externalities, primarily political. Most importantly, is there a system of morality established in my place of residence in which I feel safe in regards to myself and my family? If I earn something, do I get to keep it? Are there sufficient opportunities to earn a living to provide for my family?
3
Love/belonging
Humans are social creatures. Most of the very successful people are connectors. They help people meet other people who can then provide some sort of value in a mutually beneficial way.
4
Esteem
Self-respect, confidence, strength, mastery, independence and freedom. Esteem ultimately comes from having good relationships, practice and experience.
Self-actualisation
This means reaching full potential. By using Maslow as a model, you can determine where you should focus your first efforts in financial enlightenment; it is a good way to start.
5 (most advanced needs)
Source: Lien (2012)
SELF-CHECK 7.1 Briefly describe MaslowÊs hierarchy of needs based on the five different levels.
ACTIVITY 7.2 In small groups, discuss how you would explain the „financial happiness‰ in the context of Maslow hierarchy of needs.
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FINANCIAL HEALTH AND WELLNESS
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CHALLENGES TO FINANCIAL WELLNESS
Now we come to look at the challenges to financial wellness. It is hoped that by finding out more about these challenges, you can design plans which can help you remove obstacles to lay the foundations for your financial wellness. Let us reflect on this question: At what age do you think one is expected to be financially independent? Well, one is expected to be financially independent as one enters adulthood. This is because as a legal adult, he or she is a person who has attained the age of majority and is therefore regarded as independent, selfsufficient and responsible. Did you know that adulthood can be identified by using a marker? The passage from adolescence to adulthood is marked by the experience of particular life events. So, what are they? Traditionally, the major markers have been identified as these life events (see Figure 7.2).
Figure 7.2: Four experiences to mark adulthood
In the past, up to the era of baby boomers (born between 1946 and 1964), the passage to adulthood had been rather smooth. The emerging adults would have acquired the finesse of adulthood primarily through direct guidance and support from parents. Copyright © Open University Malaysia (OUM)
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7.2.1
Economic Challenges
The majority of Generation X-ers (born between 1965 and 1980) and boomers believe Generation Y or Millennials (born after 1980) face more economic challenges than they themselves had faced when they were first of age (Pew Research Centre, 2014). The more trying conditions faced by Millennials themselves have caused them to be realistic about their relative positions. A research poll in 2014 revealed that only 42% of the Millennials identify themselves as „middle class‰, whereas 53% of their fellow Millennials in an earlier poll (which was in 2008) had claimed themselves to be so. In fact, more strikingly, 46% of them described themselves as of lower than middle class in the recent survey (Pew Research Centre, 2014).
7.2.2
Other Challenges
Do you realise that there are more major developmental changes and challenges associated with the period of adolescence? For example, the millennial youths have to acquire and consolidate their competencies, attitudes, values and social capital necessary to make a successful transition into adulthood. Late adolescence and the period that follows (often referred to as emerging adulthood), have been noted as particularly important. It constitutes a stage for continued development as individuals begin to make choices and engage in a variety of activities that are potent influences for the rest of their lives. Take note that as youth move into emerging adulthood, their choices and challenges shift. This includes decisions related to the traditional markers of adulthood as shown in Figure 7.2. Recently, social scientists have found that the transition to adulthood is taking longer to complete. This is because becoming an adult today (for Generation Y and Millennials) is totally different from 30 years ago. This can be related to some of the contributing factors which include the following (Richardson, 2015): (a)
New economic landscape;
(b)
Changed perspectives; and
(c)
An altered path to professionalism.
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Nonetheless, the Millennials are almost as optimistic of their financial futures as Generation Xers were when they were of comparable age. Those who were employed then were confident that they were earning enough to live the life that they aspired while those who were not employed were bullish about their financial futures (Pew Research Centre, 2015). Even though emerging adults who had not moved out realised that they were pulling clear of their adolescent struggles and starting to feel responsible for themselves, they still had to cling to the lifeline of their accommodative parents (Munsey, 2006). According to Munsey, Arnett (2000) thus proposed a new period in lifespan that he called „emerging adulthood‰. This emerging adulthood has certain distinct characteristics as described in the following Table 7.2. Table 7.2: Five Characteristics of Emerging Adulthood Characteristic
Description
Age of identity exploration
Young people are deciding who they are and what they want out of work, school and love.
Age of instability
The post-high school years are marked by repeated residence changes. As young people, they either go to college, or live with friends or a romantic partner. For most, frequent moves end as families and careers are established in the 30s.
Age of selffocus
Freed of the parent and society-directed routines of school, young people try to decide what they want to do, where they want to go and who they want to be with ă before those choices get limited by the constraints of marriage, children and a career.
Age of feeling in between
Many emerging adults say they are taking responsibility for themselves, but still do not completely feel like an adult.
Age of possibilities
Optimism reigns. Most emerging adults believe they have good chances of living „better than their parents did‰ and even if their parents separate, they believe they will find a lifelong soulmate. Source: Arnett (2000)
According to Arnett (2000), emerging adults pin their hopes from life ă a job that is well paid and personally meaningful, and a lasting bond with a partner. However, Arnett is pessimistic ă many might be headed for disappointment. Most employers simply want someone who can get a job done. If happiness is the positive difference between what you actually get and what you expect out of life, then a lot of emerging adults are setting themselves up for unhappiness (Munsey, 2006). Copyright © Open University Malaysia (OUM)
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7.2.3
Contributing Factors to Delayed Adulthood
What are the factors that contribute to delayed adulthood? Well, let us find the answer in Figure 7.3.
Figure 7.3: The factors that contribute to delayed adulthood
These factors are further explained as follows: (a)
Economic Landscape Have you ever worked in a factory during school break or semester break? Most of you would say „yes‰. Am I right? In the past, even before completing school, many teenagers could work in factories, earning enough money to support themselves or family. The farsighted few would go to college and enjoy the benefits of say, supervising the production lines. However, over time, local openings became scarce as manufacturing establishments flew to cheaper jurisdictions. Aspiring school leavers soon realised they needed to scale up ă hence to college. With time, it is commonly seen that one needed to pursue tertiary education to make it. College attendance thus soared. However, with college attendance, debt ensued. Add to it the rising costs of living, food, accommodation and transportation. So, it is not a big surprise that young people often do not settle into careers and family until after their mid-twenties. The reason is that they simply do not have the money. The dominating factor is that it is taking longer for young adults to transition into adulthood. This transition period has been labelled as the „emerging adulthood‰ by some or as „in-between age‰ by others (Richardson, 2015).
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(b)
Housing Issue Did you notice that millions of young adults live with their parents? Do you know why? In fact, some young adults have failed to grasp life bravely while others just do not have the money to live independently.
(c)
Unemployment and Underemployment Did you know that nearly 75 million young people worldwide are unemployed? In fact, the global youth unemployment rate has remained at 12.6% since 2009. In Malaysia, the youth unemployment rate has remained high since the Asian financial crisis of 1998. From a low of 6.7% in 1996, the youth unemployment rate shot up to 11.3% in 2010. Even graduate unemployment rate which did not exceed 2.3% in the early 1990s before the Asian financial crisis, has since not gone anywhere below 2.9%. These figures have not yet taken into account the millions of young people who are underemployed. In addition, the cost of living, housing, healthcare and childcare are rising too, against the backdrop of increasing unemployment and underemployment. Topping it up is the impending shrinking of job opportunities among aspirants caused by higher retirement age (Asia Pacific Youth Employment Network, 2012).
(d) New Approach to Relationships The social and economic changes that contributed to the rise of emerging adulthood include the transition from a manufacturing economy to an economy based mainly on information, technology and services. This has caused more and more young people to pursue longer post-secondary education in order to prepare themselves for jobs in the new economy. Therefore, this means later ages of entering marriage and parenthood, and widespread acceptance (or at least tolerance) of premarital sex and cohabitation following the invention of the birth control pills in the 1960s. Remember, none of these changes is likely to be reversed in the expected future. For this reason, it makes sense for us to see emerging adulthood as a new life stage rather than as a generational shift that will soon shift again (Richardson, 2015).
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Take note that besides the four factors discussed just now, there are two other factors that contributed to delayed adulthood too (refer to Figure 7.3). They are described as follows: (a)
Destabilising Behaviours These behaviours can be divided into two types: (i)
Vicarious Influence Do you agree that young adults are more susceptible to the influence of celebrities rather than their elders? In other words, they tend to follow celebrities. As Boon and Lomore (2006) said „adolescents often form strong attachments to figures they encounter in the popular media.‰ Sports stars are also recognised as favourite celebrity role models for many young individuals. Athlete role models are known to influence adolescentsÊ behavioural intentions, especially with respect to relevant products (see Figure 7.4).
Figure 7.4: Christiano Ronaldo for Nike advertisement Source: http://www.nike.com
With respect to this, results of relevant research replicated locally found that both direct and vicarious role models influence the purchasing intentions and behaviour of Malaysian adolescents. In fact, the findings suggest that vicarious role models play a more influential role then the direct (parental) role models (Cyril de Run, Butt & Chung, 2010).
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Furthermore, the result seems to be at odds with the eastern values and culture believed to be well entrenched among Malaysians. Probably, it may be the effect of the following:
(ii)
Phenomenal economic growth that Malaysia enjoyed during the last three decades; or
Industrialisation and presumably westernisation of the Malaysian society have somehow influenced the cultural values of emerging adults.
Impulsive Buying What does impulsive buying refer to? Impulsive buying refers to purchases of goods and services that one had not planned to buy. Traditionally, impulse buying occurs in stores as a result of display strategies and personal selling strategies employed by retailers. Let us reflect on the following two scenarios (refer to Table 7.3). Table 7.3: Two Scenarios for Your Reflection
Scenario
Description
Scenario A
Have you experienced buying candy and chocolates that you have never planned to buy? However, you simply bought them upon noticing them at the cashier while you were about to pay for things that you had planned to purchase (see Figure 7.5).
Figure 7.5: Checkout counter Source: http://www.novograf.co.uk
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Scenario B
Have you experienced buying things online and while you are doing so, your attention was directed to a display „customers who purchase what you are purchasing also purchase these‰ (refer to Figure 7.6).
Figure 7.6: Online shopping strategy Source: http://www.lazada.com.my
What can you conclude about these two scenarios? Well, for Scenario A, retailers are emulating the display strategies and personal selling strategies of „brick and mortar‰ retailers. As for Scenario B, beware of buying things you have never planned to but impulsively did so because you have been prompted. (b)
Potent Force The last factor for our discussion is potent force. Did you realise that Generation Y is also considered a potentially large labour force? In fact, they are capable of forming a pattern of socio-economic development among various generations of a pluralistic society. Furthermore, they live in a world of technology and the Internet. Therefore, they always want something challenging and do not wish to be bored with the same daily routine. They have their own favourite social activities and most of them live in a world where they can connect and interact in a global borderless way (Alwi, Amir Hashim & Ali, 2015). Currently, Generation Y dominate more than 50% of the workforce or about 21% of MalaysiaÊs 29 million population (PriceWaterhouseCoopers, 2015).
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ACTIVITY 7.3 1.
„Emerging adulthood is a new life stage in oneÊs life cycle.‰ What do you think of this statement? Discuss the distinctive features of this „new life stage‰ and their implications on individualsÊ strive for financial wellness.
2.
Read the following article and discuss in groups: The Malaysian Insider (15 October 2015), Malaysia Gen Y in debt, living on the edge, survey reveals at http://goo.gl/Sb6dd7
7.3
ELEMENTS OF FINANCIAL WELLNESS
Now let us move on to identify the elements of financial wellness. It is hoped that by the end of this subtopic, you will be able to understand them better. Firstly, look at this finding from Financial Finesse (2013) taken from Yahoo Finance website. 62% of those surveyed who are under 30, report that they have „some‰ financial stress, and another 15% say that they have „high‰ or overwhelming levels of financial stress. How do we relate financial stress with financial wellness? Well, let us look at financial wellness first. What does financial wellness mean? Simply put, financial wellness may be defined as a state of being wherein a person can fully meet current and ongoing financial obligations, feel secure about their financial future and is able to make choices that allow him or her to harvest lifeÊs enjoyment. In addition, financial wellness is based on a continuum ranging from severe financial stress to being highly satisfied with oneÊs financial condition. Some people may seem to have, and feel they have, a high level of financial wellness even though they may seem far from affluent. On the other hand, some who seem wealthy may not appear to have, or feel they enjoy, a high level of financial well-being.
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The goals and vision of a satisfying life differs greatly among individuals. However, there are two common themes that come up consistently ă security and freedom of choice whether in the present or in the future (Consumer Financial Protection Bureau, 2015). Now let us redirect our attention to the elements of financial wellness. There are four elements of financial wellness as shown in Figure 7.7.
Figure 7.7: Four elements of financial wellness
These four elements are further described as follows: (a)
Having Control Over Day-to-Day, Month-to-Month Finances Individuals who at of a relatively high level of financial well-being feel in control of their day-to-day financial life. These individuals manage their own finances are able to cover expenses and pay bills on time, and do not worry about not having enough money to go by.
(b)
Having the Capacity to Absorb a Financial Shock Individuals who are at a relatively high level of financial well-being also have the capacity to absorb a financial shock. They are able to cope with the financial challenges of unforeseen life events.
(c)
Being on Track to Meet Financial Goals Individuals experiencing financial well-being are also said to be on track to meet their financial goals. They have a formal or informal financial plan and actively work towards goals such as saving to buy a car or home, paying off student loans, or setting aside funds for retirement.
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Having the Financial Freedom to Make Choices to Enjoy Life Finally, individuals experiencing financial well-being are able to make choices that allow them to enjoy life. They can splurge once in a while. They can afford „wants‰ such as being able to go out to dinner or take a vacation, meeting their „needs‰ and they are able to make choices such as to be generous toward their friends, family and community.
How do we relate these four elements to the two common themes of financial wellness? Well, let us look at Table 7.4 for the answer. Table 7.4: Relationship between Common Themes and Elements of Financial Wellness Theme
Present
Future
Security
Control over your day-to-day, month-to-month finances
Capacity to absorb a financial shock
Freedom of choice
Financial freedom to make choices to enjoy life
On track to meet financial goals
Source: Ratcliffe (2015)
Now, how do we balance this? Well, let us look at Figure 7.8 for an answer.
Figure 7.8: Live by a budget to achieve financial wellness
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Here are some suggestions on what you should do specifically: (a)
Sign up for a retirement plan;
(b)
Automate your savings;
(c)
Establish a „freedom fund‰;
(d)
Pay off your debts;
(e)
Put your goals in writing;
(f)
Track your own credit score (keep old credit card open; pay your bills on time, every time; avoid full utilisation of credit card eligibility; and keep below 30% of your available line of credit);
(g)
Understand your taxes; and
(h)
Manage your finances closely.
Table 7.5 gives you some dos and donÊts to improve your credit scores. Table 7.5: Dos and DonÊts to Improve Your Credit Scores Dos Pay your bills on time. Keep your credit card balance low. Be patient.
DonÊts Do not be afraid of credit. Using credit wisely is important to becoming financially successful. Avoid extravagance. Keep to the basic as this will help you lay a stronger overall financial foundation. Go for luxury when you are more financially secure. Do not let borrowings get you down. Some critics question whether a study loan is worth it. The answer is yes. Research has shown that an education loan will pay off over the course of your career. Do not let jom jalan-jalan interfere with your budget. Be sure to have a written budget to help keep track of spending and what you can afford to spend on. Be sensitive of your credit rating.
Source: PR Newswire (2015); DiGangi (2015) Copyright © Open University Malaysia (OUM)
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SELF-CHECK 7.2 Explain what the elements of financial wellness are.
ACTIVITY 7.4 Share with your course mates whether you possess the elements of financial wellness or not. Justify your answers.
7.4
FINANCIAL FITNESS
Before we end this topic as well as this module, let us look at financial fitness. Hopefully by the end of this subtopic, you will be able to evaluate your financial fitness. Let us begin by looking at the findings from PriceWaterhouseCoopers (2015). Over the years employers have learned that improving the health and wellness of their workforce yields benefits for both employers and employees alike. Employers enjoy a healthier workforce that is more productive, has fewer absences and makes fewer demands upon employer-sponsored health insurance. Employees benefit from improved health and well-being, and reduced medical expenses. From these statements, we can conclude that financial wellness programmes can educate employees about the financial risks they face and provide tools to manage those risks. Therefore, workplace financial wellness must meet the following criteria in order to be marketed as a financial wellness benefit (not to be confused with financial education or financial advice) (Financial Finesse, 2014): (a)
Unbiased ă Free of sales pitches or conflict of interests;
(b)
Designed and delivered by qualified experts who have extensive financial planning experience;
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154 TOPIC 7 FINANCIAL HEALTH AND WELLNESS
(c)
Delivered as an ongoing process ă Provide the support and accountability that employees need to make, sustain and build upon positive financial habit and behaviours;
(d)
Holistic and comprehensive in nature ă Covers all aspect of financial planning from debt management to more advanced estate planning;
(e)
Personalised to the employee based on their specific needs;
(f)
Integrate all employee benefits ă With guidance on how employees can most effectively manage their benefits as part of their overall financial plans; and
(g)
Offered as a benefit available to all employees.
Last but not least, below are five elements you need to heed in your financial budget (see Figure 7.9).
Figure 7.9: Five elements of financial budget
That marks the end of this topic. Hopefully, you have gained some insightful knowledge on health and wellness, and is now able to come up with a plan to stay healthy and well (physically and financially). Remember, health is wealth!
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ACTIVITY 7.5 1.
2.
Evaluate your financial wellness by answering the questions given. Award yourself 1 for Yes and 0 for No. Tally your score. Then, ponder over your result with your friends. (a) Do you pay yourself first? Set aside a certain amount for savings, retirement or investing before you do anything else.
(b) Do you save at least 10% of your income? Meaning that at the end of each year, you must have set aside more than one month of your salary for the future.
(c) Have you set aside an emergency fund to cover at least three monthsÊ worth of expenses? This is to soften the blow if any unpredictable event occurred.
(d) Do you know the exact amount of your debt and the payables?
(e) Do you accelerate the payments of your debt? Remember, debts can snowball as a result of the compounding process.
(f)
Do you have financial goals? Short, medium as well as long-term goals?
(g) Do you have a record keeping system?
(h) Do you live within a budget?
(i)
Do you know your net worth?
Construct your budget for the current month. Make sure to list out all the items in your financial health evaluation.
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156 TOPIC 7 FINANCIAL HEALTH AND WELLNESS
Financial health is a term used to denote „the state of oneÊs personal financial situation.‰ There are many dimensions of financial health such as disposable income, savings and loan repayments.
Financial fitness is just like physical fitness; one has to do things in certain ways to be physically fit. Similarly, in order to be financially fit, one must handle oneÊs finances in a proper balanced manner ă managing oneÊs expenses, savings, debts and others in a befitting manner.
The impact of a poor financial state can be compounded by widespread job losses, declining asset values, great drops in value of savings. These adverse phenomena can leave many in a state of financial distress.
Financial distress is a term in corporate finance which describes a situation where a company fails to honour its promises to pay its creditors according to the agreed term of credit. If financial distress cannot be relieved, it may lead to bankruptcy.
Markers of adulthood refer to acquisition of social roles and responsibilities that traditionally mark the process of becoming an adult. These markers include the following: ă
Leaving home;
ă
Entering the labour force market;
ă
Marrying or becoming a parent for the first time; and
ă
Assuming financial independence.
Challenges confronting the emerging adults in their quest for financial wellness can be categorised into economy challenges. Generation Y or Millennials (born after 1980) face more economic challenges than Generation X and Generation Y.
Emerging adulthood is a phase in oneÊs life span between adolescence and full-fledged adulthood which is considered to be developmental in nature. It is a distinct period between 18 and 25 years of age wherein one struggles with identity exploration, instability, self-focus and feeling in-between.
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There are four elements of financial wellness: ă
Having control over day-to-day, month-to-month finances;
ă
Having the capacity to absorb a financial shock;
ă
Being on track to meet financial goals; and
ă
Having the financial freedom to make choices to enjoy life.
Financial wellness programmes can educate employees about the financial risks they face and provide tools to manage those risks. This can help them to develop their financial fitness plan.
Adulthood
Financial shock
Baby boomers
Financial wellness
Emerging adulthood
Generation X
Financial distress
Generation Y
Financial fitness plan
Make choices
Financial freedom
Markers of adulthood
Financial goal
Millennials
Financial health
Pecking order
Financial independence
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Alwi, S., Amir Hashim, I. Z., & Ali, M. S. (2015). Factors affecting savings habit
within millennials in Malaysia: Case study on students of TaylorÊs University. Retrieved from http://globalbizresearch.org/Malaysia_Conference/pdf/KL539.pdf Arnett, J. J. (2000). Emerging adulthood: A theory of development from late teens through the twenties. American Psychologist, 55(5), 469ă480. Retrieved from http://jeffreyarnett.com/articles/ARNETT_Emerging_Adulthood_theory. pdf Asia Pacific Youth Employment Network. (2012). Malaysia: Challenging times for the YOUNG: But do the OLD have easier? Retrieved from http://www.apyouthnet.ilo.org/news/malaysia-challenging-times-forthe-young-but-do-the-old-have-it-any-easier Boon, S. D., & Lomore, C. D. (2008). Admirer-celebrity relationship among adults: Explaining perceptions of celebrity influence on identity. Human Communication Research, 27(3), 432ă465. Retrieved from http://www.researchgate.net/publication/229593453_Admirercelebrity_relationships_among_young_adults Consumer Financial Protection Bureau. (2015). Financial well-being: The goal of financial education. Retrieved from http://files.consumerfinance.gov/f/201501_cfpb_report_financial-wellbeing.pdf Cyril de Run, E., Butt, M., & Chung, Y. N. (2010). The influence of role models on young adults purchase. Jurnal Kemanusiaan, 15, 70ă81. Retrieved from http://www.management.utm.my/jurnalkemanusiaan/attachments/article/116/JK15_116.pdf DiGangi, C. (2015). Millennials have low credit scores: HereÊs what they can do about it. Retrieved from http://blog.credit.com/2015/08/millennials-have-low-credit-scores-hereswhat-they-can-do-about-it-122735/ Drakopoulos, S. A., & Grimani, K. (2015). The effects of pay cuts on psychological well-being and job satisfaction. Retrieved from http://mpra.ub.uni-muenchen,de/61195.pdf Copyright © Open University Malaysia (OUM)
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Financial Finesse. (2014). Financial FinesseÊs official definition of financial wellness. Retrieved from http://www.financialfinesse.com/wpcontent/uploads/2014/09/Financial_Wellness_Defined1.pdf Financial Finesse. (2014). Financial Finesse releases 2013 research report on employee financial stress. Retrieved from http://finance.yahoo.com/news/financial-finesse-releases-2013-research165800163.html Lerner, M. (2015). 6 tips to make you happier financially. Retrieved from http://www.dailyfinance.com/2015/04/29/6tips-happier-financially/ Lien,
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Ratcliffe, J. (2015). Four elements define personal financial well-being. Retrieved from http://www.consumerfinance.gov/blog/four-elements-define-personalfinancial-well-being/ Richardson, M. (2015). Emerging adulthood and millenials crayons to careers: The modern way to reach adulthood. Retrieved from http://health.abc4.com/articles/1938/Crayons-to-Careers Securian Financial Group. (2010). Financial wellness: Tuning in to the total health model. Retrieved from http://www.lifebenefits.com/lb/pdfs/F62382-28.pdf University of Wisconsin River Falls. (n.d.). Wellness assessment. Retrieved from https://www3.uwrf.edu/Wellness/assessment.cfm World Health Organization, Western Pacific Region. (2011). Health of adolescents in Malaysia. Retrieved from http://www.wpro.who.int/topics/adolescent_health/malaysia_fs.pdf Zarrett, N., & Eccles, J. (2006). The passage to adulthood: Challenges of late adolescence. New Directions for Youth Development, 111, 13ă28.
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