Quality of life is significantly influenced by people`s lifestyle habits

Andrew is a middle class European male aged 19. He can be classified as overweight bridging on obesity. Recently when visiting his GP, he was informed that he is at a high risk of becoming a type 2 diabetic. Andrew is unsure about how to adapt a healthier lifestyle as he has grown up in an environment surrounded by unhealthy lifestyle choices. He is not motivated to prepare his own food, so generally eats packaged foods consisting of a high fat, high carbohydrate diet, low vegetable and fruit intake. He has never been popular or good at sports, and tends to view physical activity in a negative light due to being bullied by members of prominent sport teams. This has lead to his disidentification with and avoidance of sport associated activities. Andrew spends most of his free time playing computer games and does not often socialize outside of online gaming communities.
Regular physical activity (PA) is critical for a healthy lifestyle (Rhodes et al. 1999). Poor physical exercise has been recognised as a crucial factor for illnesses such as heart diseases and diabetes (US Department of Health, 1996). Lifestyle changes over a sustained period can significantly reduce the risk of cardiovascular diseases (CVD), morbidity and mortality as much of the benefits accrued occur in the long term (Artinian, N., Fletcher, G., Mozaffarian, D., Kris-Etherton, P., Horn, L. et al. 2010). Studies indicate that, independent of other factors, being physically active as opposed to sedentary can significantly lower one`s risk of developing diabetes (Helmrich, 1991). Bevahiral and lifestyle changes including dieting and physical exercises are some of the most effective ways of addressing the risks of CVD, diabetes type II and obesity (Artinian et al., 2010)
There are a number of cognitive behavioral strategies that can be employed in the current case of Andrew. Artinian et al. (2010) suggest goal setting, self monitoring, frequent and prolonged contact, feedback and reinforcement, self efficacy enhancement, incentives, modeling, problem solving, relapse prevention and motivational interviewing. Therefore, intervention in the case of Andrew will involve applying the above strategies simultaneously. Part of the behavioural change expected in using the above strategies is not only on physical exercise but also on dietary changes. Intervention will also address Andrew`s dietary habits. Andrew`s diet is poor as it mainly consist of processed foods high in carbohydrates and proteins but lacking in fruits and vegetables.
To induce behavioral change the health belief model will be applied (Sharifirad et al 2008). The authors continue to that this model (henceforth HBM), advocates that individuals have choices in regards to their health, but the choices they make depend upon their belief about their susceptibility to the illness, the severity of the illness, the benefits of taking action, and perceived barriers. Studies indicate that programs utilizing the HBM, where the individual learns about dietary planning, energy intake, number of meals, significantly increase ones nutritional knowledge, and can alter attitudes [Rhodes et al 1999]. Findings also show increased perception of the dangers of poor diet, and perceived benefits of healthy diet after intervention (Borzou & Biabangardi 1999). The study by Sharifirad et al (2008) showed an 80% awareness score after intervention compared to 57% awareness score before intervention. Another study by Heidari et al (cited in Sharifirad et al 2008) showed significant improvement of awareness score after intervention.
Setting of goals at the commencement of an intervention program is important in achieving desired behavioral change. Goals should be specific in order to increase performance and dedication as opposed to vague goals. Furthermore, goals that focus on behavior are preferred to goals that focus on a physiological target. For Andrew, a possible goal could be the distance walked on a daily basis or minutes of extreme to medium physical activity. Goal-setting can be combined with self monitoring. Self monitoring facilitates recognition of progress towards the set goals. For instance, Andrew can self-assess how soon he manages to achieve the set goal of minutes of walking per day.
HBM suggests that for people to engage effectively in interventions they will need to comprehend two facts they are currently at `risk`, and that they will benefit from engaging in the desired behavioural modification (Heidari et al. 2002). Applying HBM to Andrew involves raising awareness of both the risks associated with his current lifestyle, and the benefits of engaging in the recommended behaviour. Further, the intervention will help to remove any of Andrew perceived barriers, increase awareness of perceived benefits and barriers.
Both the Theory or Reasoned action and Theory of planned behaviour emphasizes the importance of the behavioral intention to initially get someone to adopt a behavior (Ajzen & Fishbein 1980). This is noted to be a central predictor of behavioral change. This means that for Andrew, the behavioral intention will be determined by the attitude towards it and the subjective norms. Subjective norms in this case could be the family`s view of whether he should perform the behavior suggested. This means that the family has a huge role to play for Andrew to effectively take up the intervention.
Engaging the family can help increase motivation and control of healthy lifestyle (Nowicka & Flodmark, 2011). Research suggests that the direct involvement of at least one parent as an active participant in the weight loss process improves short and long-term weight regulation. The systems theory is a dominant paradigm in intervention programs that involve family members, as there is a proven significant correlation between family support and adherence to intervention programs (Pardeck 2002). In the case of Andrew, the mother selects the food for the family hence her role and other family members has a significant bearing on the program.
Understanding an individual`s perceived self-efficacy is important, as it should be incorporated in the intervention program (Artinian et al., 2010). According to Bandura (1986), there are four main sources of self-efficacy with the two major ones being mastery experiences and vicarious experiences. Mastery experiences calls for individuals to target and achieve goals that are reasonable and proximal. In the case of Andrew, a proximal and reasonable goal would be to eat a fruit every day, minimize the intake of soda, and increase uptake of fresh juice. On the other hand, vicarious experience involves identifying a peer in a similar situation with similar capabilities who achieves targeted goals successfully (Artinian et al., 2010). In the case of Andrew, this might involve a person who has in the past been eating unhealthy processed foods but has transformed to making his own healthy meals at home. Such an example offers motivation to Andrew and shows him that his goals too are achievable.
Video games can also be engaged in the intervention. Although video games have predominantly been blamed for encouraging a sedentary lifestyle, a new range of interactive games are being used as a intervention tool to fight obesity in clinical studies (Jordan-Marsh 2010). Jin (2012) provides insights for both health promoters and the gaming industry with regard to message framing for health products. Innovative products are being developed in order to help enhance people`s PA and help with weight management (Jin 2009). Video games motivate a remarkable amount of goal directed behaviour and evidence suggests that video games may enhance wellness (Przybylski, Ryan, Rigby, 2010). Health professionals should capitalize on the use of exergames.
For Andrew`s case, exergames and interactive video games should be introduced to his daily routine. Jin (2012) indicates that there is a positive correlation between actual self and ideal self in these games. Players had greater dieting intentions to fit with the ideal self activated in a game. Therefore, it is possible to get Andrew to be motivated to diet through playing exergames where he can activate an ideal self in the game and identify with it in real life psychologically and behaviorally. Higgins (1997) puts forth two theories that show how exergames work regulatory focus theory and self discrepancy theory. Our interest is in the latter. Self discrepancy theory divides the concept of self into three: the actual self, ideal self and ought. The exergame introduced should be simple so as to entice Andrew to play through the various levels this will satisfy the competence need (Przybylski, Ryan & Rigby, 2010). This should create an interest in the game the latter levels should be difficult for the player to complete to create interest and new challenges.
Future research should investigate the outcomes of exergames such as affective responses such as psychological involvement and behavioral outcomes such as exercise intentions and food choice behaviour (Jin 2009). Furthermore, future exergames should explore more games and sports to engage players. The current exergames in the market require a lot of time to play, specialized hardware and are tedious to set up. These are some of the considerations that future exergames should address. This will promote increase use in weight loss intervention programs especially those involving the youth.
Exergames are comparatively better than physical exercise in various ways. Jordan-Marsh (2010) lists several of them. One of them is they are more efficient in preventing physical injury especially to the aged and youths are who are obese. Furthermore, exergames are more efficient than traditional form of exercise because they are interactive in nature and therefore engage players cognitively because it most the games require players to anticipate events and respond to them while playing. Therefore, exergames also promote cognitive functioning. This is in addition to their benefit of promoting physical well being and fighting obesity.
Change of diet has been called non-self regulatory style, but we also see self-regulatory style playing a part too because Andrew can choose to follow the measure stipulated or simply choose to abandon them (Pelletier et al, 2004). According to the self regulatory style, people do try to control what they eat, but may not succeed. The desired dieting should result from self directed behavior change which is acquired through persistence (Pelletier et al 2004).
This theory ties the style of regulation to the nature of motivation. Motivation takes three shapes extrinsic, intrinsic and motivation. Internal motivation stems from a personal level to change eating behavior while external is more reward oriented. According to Rise et al (2010), there is no certain link between intention and behavior change. However, the theory of planned behavior suggests that conduct is influenced by a series of intentions, as well as, the foreseeable degree of control over such a conduct (Povey & Mark Conner 2000). Two aspects however have stood out in the theory of behavior change. These are self efficacy and perceived behavior control.
Another way that Andrew can get to change his dietary habits is through self efficacy. Self efficacy influences behavior (Terry and O`Leary 1995) and is critical at all phases in the health behavior change procedure (Bandura, 1997) and in the initial adoption of physical activity exercise (McAuley, 1992). Perceived self-efficacy is important in driving dietary change devoid of the underlying skills. This is very important since in the case of Andrew, he is likely to initiate change until success is achieved (Bandura, 1997).
From the above discussion on the case of Andrew, it is apparent that the intervention plan will involve his capabilities, his wiliness, his desire, and input from the family and peers. The activities of the intervention plan are supplementary in nature. For instance, exercise alone will suppress appetite. The family will engage Andrew, play its part by motivating him and ensuring that he has increased access to healthier food, and also limit the intake of junk foods. In light of exergames, the family can not only make the games available but some family members should take to playing the games with Andrew where multiple players are applicable. The family can also play a role in assisting Andrew acquire vicarious and mastery experiences. For vicarious experiences, Andrew should be introduced to persons who have undergone weight loss intervention programs and also ensure that he sets up realistic goals and he achieves them.
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