Nutrition, Health, and Stress

Your lifestyle can be a source of both stress and strength. The word lifestyle refers to those habits and activities that characterize your daily life, such as eating and sleeping habits and recreational pursuits, to name a few. In this section, you will learn how your lifestyle affects your ability to cope effectively with stress.

    Lifestyle affects your stress resistance in two important ways. First, your lifestyle can increase your stress resistance by giving you more energy and optimism each day, thus enhancing your productivity, your coping ability, and most of all your enjoyment of life. Second, it can help keep you healthy, or at least minimize the time you lose from your regular routine because of illness. We take our health for granted-until it's not there; then we realize how much we depend on being healthy to be able to do all the things we do. Getting sick can take us out of commission for days, weeks, and even longer: A project that might have taken an hour or two to complete on a good day can remain in fragments after an entire workday when we are frazzled and unable to concentrate. Feeling tired can turn the simplest schedule into an impassable mountain. Of course, no matter how well we take care of ourselves, we all get sick from time to time, and we all have bad days. That makes it even more important to control the things we can to make our days run as smoothly as possible. Optimal health and well-being are not things that just happen. We control many of the factors that affect our good humor and energy level. We emphasized in Chapter I that self-responsibility is the cornerstone of the wellness philosophy. We are responsible for developing health habits that not only keep us healthy but also help us maximize our good days. In this section you will see how a little organization and time management applied to your health behavior can significantly increase your stress resistance.

NUTRITION AND STRESS: RUNNING ON EMPTY

Good nutrition and eating habits contribute significantly to good health and stress resistance. They are especially important during high-stress times, but these may be the times when we are least likely to eat well (Stone & Brownell, 1994)! The cupboard is bare, we have no time to plan a shopping list and no money to go shopping, so we skip meals or grab whatever fast food is closest at hand. Sometimes we depend on a dining hall whose schedule doesn't match our own, or whose ideas of good nutrition and fine cuisine are limited to meat, potatoes, and overcooked vegetables with lots of butter. Dessert is usually the high point of every meal.

    Good nutrition improves both short-term and long-term stress resistance. Short-term stress resistance requires a working brain. A poor diet can lead to malnutrition, low blood sugar, and other chemical imbalances. With an inadequate diet, the brain loses power; the symptoms can include anxiety, headache, fatigue, irritability, and dizziness. Our ability to think clearly diminishes; taking exams, completing assignments, and writing papers all become much more difficult. When we are fatigued, molehills turn into mountains. We feel out of control, less able to cope with the demands facing us, and unable to come up with creative ideas.

    In the long run, poor nutrition wears us down. We are more likely to get sick with every cold and flu germ that comes along. Poor nutrition also contributes to chronic health problems such as artery disease, obesity, high blood pressure, some types of cancer, and gastrointestinal problems (Katch & McArdle, 1993). Good nutrition promotes high-level wellness and gives us the good health and energy we need to solve problems creatively and to cope with the stressors that come our way (Davis, Esheman, & McKay, 1995).

STRESS, HEALTH, AND THE AMERICAN DIET

North Americans reap many benefits from living in the land of plenty. One of the unfortunate side effects, however, is that we often have problems with food. We eat too much of the wrong things, get too fat or worry about getting fat, go on crazy diets, and have a hard time developing a healthy relationship with food. We are bombarded with nutrition information and misinformation, much of it confusing and contradictory. Eating a healthful diet without getting obsessed with food and weight can be a challenge.

    Many authorities believe that the American diet contributes to a number of our health problems. While in many parts of the world a lack of food is associated with poor health, our problem is generally just the opposite: overnutrition. We consume too many calories for our sedentary lifestyles, especially the wrong kinds of calories: fat and sugar, which contribute to our high rates of obesity and many of our leading causes of death and chronic illness.

    Healthful meals take some organization and planning ahead; when households get busier, fewer meals are prepared and consumed at home. A large part of the overnutrition problem is our penchant for fast food and processed food products, which are convenient, affordable, and readily available. Many fast foods and supermarket convenience foods tend to be high in fat and sugar and low in nutritive value. The next time you visit the supermarket, take note of what you see in the aisles. How much of it is "real food" unchanged from the farm to the store? A small percentage, found mostly in the produce aisle. The rest is products. Corn made into corn syrup made into soft drinks, grains made into flour made into cookies. Of course, some food products are very healthful, but you must read labels to learn what is in food and what has been done to it.

NUTRITION BASICS

A comprehensive review of nutrition is beyond the scope of this chapter, but a few concepts will help you understand how nutrition affects your stress resistance. The nutrients needed for all life processes are divided into six categories based on their chemical composition: Carbohydrates, proteins, lipids, vitamins, minerals, and water.

Three classes of nutrients provide the energy you need. The primary function of carbohydrates is to provide energy. Complex carbohydrates, or starches, are found in plant foods such as grains, vegetables, and fruits; they are broken down more slowly than simple carbohydrates, or sugars. Sugars are found in fruits and vegetables as well as milk; they are especially concentrated in sweeteners such as table sugar, honey, and molasses. Products made from grains (pasta, bread, and breakfast cereal, for example) contain complex carbohydrates and sometimes sugars as well.

    Proteins are found in most foods. Animal products such as eggs, meat, and milk are especially high in protein. Protein is also found in legumes such as soybeans, lentils, and split peas; grains and their products; and nuts and seeds. The body uses protein in many important ways and generally does not break down too much protein for energy except during prolonged exercise.

    The lipid category includes dietary fats and oils. These provide the body with concentrated sources of energy and are easily converted to body fat, or adipose tissue, another concentrated source of energy. This is why a small amount of fat in the diet goes a long way. Lipids provide the body with nine calories per gram while carbohydrates and proteins provide four calories per gram.

Vitamins, Minerals, and Water: Essential for Health and Stress Resistance

People do not obtain energy from the chemical structure of vitamins, minerals, or water, but these nutrients provide important components for the metabolic processes that produce the energy required for growth, development, and all life functions. Vitamins are organic molecules that the body cannot manufacture-at least not in the amounts required for good health. We must therefore obtain vitamins from food or other sources. (We can manufacture vitamin D given enough sunlight, and friendly bacteria that live in the gut manufacture certain B vitamins.) Minerals are classified as inorganic (they contain no carbon). They are required for many metabolic processes and also form various structural components in the body, such as bone. Water is the most essential nutrient. Water makes up about 50 percent to 60 percent of the body's weight and has many essential physiological functions. It is important for proper digestion, transports nutrients and wastes, and helps regulate body temperature.

Everyone has experienced the fatigue and irritability that can result from being hungry. While many of the body's systems can make energy from fat, the central nervous system, including the brain, relies primarily on blood sugar, or glucose, for fuel. When blood sugar falls, these symptoms of fatigue result. Parents and people who work with children have observed the hungry-cranky connection on many occasions. As adults, we tend to attribute our moods to external events and ignore our internal physiology, but hunger can cause crankiness in us just the same.

    Where does blood glucose come from, and what can you do to keep it on an even keel? Blood glucose level is maintained within a fairly narrow physiological range, since either very high or very low blood glucose levels interfere with central nervous system regulation. The result is shakiness, anxiety, disorientation, and in extreme cases, loss of consciousness and even death. The glucose in your bloodstream can come from the digestion of food or from the breakdown of storage molecules. These storage molecules include a carbohydrate called glycogen stored in the muscles and liver, and amino acids (the building blocks of protein) stored in the liver. After you consume a meal, your blood glucose level rises as sugar enters the bloodstream from the digestive tract. A rising blood sugar level signals the pancreas to release insulin. Insulin is a hormone that allows sugar to enter the cells and be used for energy. As the glucose gradually leaves the bloodstream, blood glucose levels begin to decrease. When glucose levels fall below a certain point, other hormones, including one called glucagon, produced by the pancreas, are called on to encourage the production of glucose from glycogen and other precursors, and the glucose level rises. (See Figure 9.1.)

    With all this regulation, why doesn't blood sugar stay at optimal levels? Your body expects to be fed, and eating behavior plays a role in blood sugar regulation. Your body gets used to being fed at certain times, and seems to "learn" to be hungry at mealtimes. If hunger is not satisfied it does eventually subside for some people, but most of us will feel somewhat hungry and out of sorts until we eat something. Some people have more trouble regulating blood sugar than others and are prone to hypoglycemia, or low blood sugar, especially if they forget to eat or when they participate in physical activity. Symptoms of hypoglycemia include hunger, shakiness, nervousness, dizziness, nausea, and disorientation. These symptoms are partly due to the effect of the hormone epinephrine, which is released when glucagon fails to do its job of raising blood glucose. As you know, epinephrine is one of the hormones that supports the fight-or-flight response; one of its jobs is to raise the blood glucose level to give you the energy required to fight or flee. That's why the side effects of hypoglycemia feel like stress! Recommendations for keeping your blood sugar at a healthful level without peaks and dips are discussed in the next sections.

Eat Regularly

Your body likes a regular schedule. Skipping meals means guaranteed hypoglycemia in people prone to this condition. Set up times for meals and snacks that are convenient for your schedule and stick to this routine as much as possible. This may mean planning ahead and carrying snacks with you if you are at work or out running errands. Many people, including those with hypoglycemia, find that eating five or six small meals or snacks each day helps them feel more energetic than three large meals.

Carbohydrate foods eaten without foods containing much protein are digested and enter the bloodstream quickly and are thus likely to challenge blood sugar regulatory processes in people prone to hypoglycemia. Protein slows digestion and allows blood sugar to rise more gradually. Protein servings may be small: a slice or two of meat or cheese; a half-cup of cottage cheese, yogurt, or tuna salad; small servings of fish or shellfish; a dish made with lentils or other legumes; or soy products like tofu.

When you eat a large amount of carbohydrates, blood sugar rises quickly. A high blood sugar level calls forth a high insulin response, which in some people causes a sort of rebound effect: glucose enters the cells, and the blood sugar level drops quickly, causing hypoglycemia. While you may feel energized for a short period of time after too much sugar, you may eventually begin to feel tired, irritable, and hungry.

Everyone recommends eating a good breakfast, but some people just can't look food in the face first thing in the morning. If this is true for you, carry a healthful snack to eat later in the morning.

Most people feel relaxed and lazy after a big feast. For this reason many cultures have incorporated a siesta after the large midday meal, and professors who teach a class right after lunch or dinner rarely turn out the lights for a slide show. Why do we feel tired? Certainly our blood sugar should be adequate after eating all that food. Changes in brain biochemistry may be the reason (Wurtman with Danbrot, 1988; Wurtman & Wurtman, 1989). The food we eat supplies the precursor molecules for manufacturing neurotransmitters that inflence our emotions and mood. Some researchers believe that by selecting the right kinds of food we can encourage states of relaxation or alertness.

    Big meals, especially those with a lot of fat, take a long time to digest, and with a full stomach we feel like relaxing rather than working. On the other hand, smaller meals low in fat take less time and energy to digest and leave us feeling more energetic and alert.

    Meals that are composed primarily of carbohydrates encourage production of the neurotransmitter serotonin, which makes us feel drowsy and relaxed. High-carbohydrate meals are a prescription for relaxation and may be the reason some people overeat: it makes them feel good. A small, high-carbohydrate snack before bedtime can encourage sleep. Many people find that eating carbohydrates helps them feel less stressed and more relaxed. Some people find that a meal or snack with carbohydrate but little protein, especially in the middle of the day, leaves them feeling tired.

    Meals that include a small serving of protein foods, with or without carbohydrates, encourage alertness by favoring production of neurotransmitters such as dopamine and norepinephrine. A small lunch that includes protein foods is best for students who need to stay alert for a 1:00 class.

GOOD NUTRITION FOR STRESS RESISTANCE AND HEALTH

So you've got your blood sugar and neurotransmitter levels under control. What else should you be aware of as you select foods during the day? A few suggestions are offered in the next sections (see also Figure 9.2).

FIGURE 9.2 Food Guide Pyramid: A Guide to Daily Food Choices
Source: US Department of Agriculture/U.S. Department of Health and Human Services

Eat More Fruits, Vegetables, and Grains

You get carbohydrates for energy, many important vitamins and minerals, and fiber that helps regulate digestive function from fruits, vegetables, & grains. Some types of fiber found in these foods also help slow the release of glucose from the digestive tract into the blood; they also lower blood cholesterol. Some vegetables, such as soybeans and other legumes (often referred to as dried beans and include pinto, navy, and black beans; lentils; and split peas) are good sources of protein; they are especially important for people who consume no foods from animal sources. All these foods contain a wide array of vitamins and minerals and are generally low in fat. We call these foods nutrient dense, which means they supply a lot of nutritive value per calorie.

    You can add these foods to your diet in several low-fat ways. Eat more salads and steamed or raw vegetables. Root vegetables such as potatoes, yams, and carrots are simple to cook. Try various grain products, such as rice, kasha (buckwheat), and couscous. Add canned beans, such as kidney and garbanzo beans, to salads and casseroles. Soups made from black beans, split peas, and lentils are delicious and easy to prepare. Fruit is a tasty, nutritious, and convenient snack and dessert food.

Keep an Eye on Fat and Sugar

  You have probably heard by now that fat is the enemy. Too much dietary fat is thought to contribute to artery disease, stroke, obesity, and cancer. The most common dietary recommendation heard today is to replace high-fat foods with those high in starch and fiber: skip the steak and eat more potatoes. Why is fat such a problem? Fat metabolism raises the blood cholesterol level,  which increases risk of artery disease. A high fat intake also leads to obesity and associated risk factors such as type 11 diabetes and hypertension. Fat is calorically dense, which means it offers little nutrition but a lot of energy (calories). A small amount of cheese, cream sauce, or whipped cream goes down easily. You don't feel like you have eaten a lot, but you have. Remember that a gram of fat contains over twice the number of calories provided by a gram of protein and carbohydrate. And while your body uses up some energy converting dietary protein and carbohydrate
to body fat, the conversion of dietary fat into body fat is biochemically simple and efficient. Dietary fat tends to go straight into storage. You can decrease your intake of fat by avoiding food products with added fats and oils: potato chips, roasted nuts, and similar snack foods. Many baked goods are high in fat: doughnuts, cookies, cakes, and pies. Whole milk, cream, and their products, such as yogurt, ice cream, butter, and cheeses are very high in fat. Skim milk and its products, such as nonfat yogurt and cottage cheese are very low in fat.

    Choose lean cuts of meat rather than meats like bologna, salami, bacon, sausage, and prime rib. Removing the skin from poultry eliminates much of the fat. Avoid fried and especially deep-fat fried anything.

    Sugar has gotten a lot of bad press and may not be as terrible as it is often portrayed. A little sugar in a healthful diet is not harmful; indeed, natural sugar is present in many nutrient-dense foods (Clark, 1990). Problems occur when too much sugar in the form of candy, cookies, and other treats replaces healthful meals. Most North Americans need to consume less sugar and limit "empty calories." An exception is people who are physically active and thus can have a higher daily calorie allowance. People with a high energy expenditure can consume more empty calorie foods, assuming their basic diet is fairly nutritious.

    Sugar is found in sweeteners and is added to many food products-from ketchup and peanut butter to breakfast cereal and yogurt. Read labels. Anything with "ose" or "syrup" in its name is a sugar: dextrose, maltose, sucrose, lactose, corn syrup, and malt syrup are some examples.

Keep an Eye on Salt Intake

A high-salt diet contributes to high blood pressure in many people. Salt and stress probably interact, since hormones contributing to the stress response regulate salt and water balance ("Stress, salt, and blood pressure," 1993). Even people without high blood pressure should probably approach salt intake with caution, since a diet high in salt appears to be damaging to arteries even in the presence of normal blood pressure. A high-salt diet can exacerbate the water retention many women experience with PMS (premenstrual syndrome). Water retention causes symptoms such as irritability and nervousness.

    Like sugar, salt is added to many processed foods, including pickled foods; condiments such as ketchup, soy sauce, mustard, and relish; snack foods like nuts, pretzels, chips, and crackers; canned soups and sauces; and processed meats such as ham and salami. Watch out for Chinese food (sodium is found in monosodium glutamate, soy sauce, and other common ingredients) and pizza (salt in tomato sauce, cheese, and meat toppings).

Drink Plenty of Fluids

Many people fail to maintain optimal levels of hydration. The next time you feel tired, try drinking a glass of water. Dehydration causes fatigue and irritability. Thirst is not an adequate indicator of dehydration; you become dehydrated before you get thirsty. Nutritionists advise drinking at least four cups of fluid each day, more with physical activity or hot weather. Caffeinated and alcoholic beverages don't count. Not only do they increase your stress but they also dehydrate you and thus increase your fluid needs. Your urine will be pale if you are adequately hydrated; dark-colored urine is a sign of dehydration (Clark, 1990).

Limit Caffeine

Caffeine is a sympathomimetic substance, which means its effects mimic those of the sympathetic nervous system and thus cause the fight-or-flight response. If you add caffeine to an already aroused sympathetic nervous system, the results can be stressful and produce high levels of anxiety, irritability, headache, and stress-related illness (Van Dusseldorp et al., 1992; MacDougall, Musante, Castillo, & Acevedo, 1988). Most caffeine drinks, including coffee, tea, and cola soft drinks can also cause stomachaches and nausea, which often get worse under stress ("Caffeine," 1994).

    One or two caffeinated beverages consumed judiciously at appropriate times during the day appear to do no harm for most people (Witters, Venturelli & Hanson, 1992). Indeed, a little caffeine can increase alertness. The problem with caffeine is that people are likely to overindulge in it when they are stressed. When summoning the energy necessary to get through the day feels like trying to squeeze water from a rock, they reach for a shot of caffeine. Caffeine cannot substitute for a good night's sleep, however. When you are truly fatigued, caffeine does not help you concentrate; it simply leaves you wired, too jittery to sleep, and too tired to do anything productive.

    Caffeine tolerance varies from person to person. Some people who forgo caffeine find they have a more even flow of energy throughout the day without caffeine's energy peaks and valleys. Some people find that any amount of caffeine causes undesirable symptoms such as anxiety and an irregular heartbeat. Others find that one or two cups stimulate them without putting them into overdrive, especially if their eating habits are good (see Table 9.1).

    Caffeine is broken down very slowly, so it remains in the bloodstream for many hours. If you have trouble sleeping at night, try to refrain from consuming caffeine in the late afternoon and evening, and see whether your sleep pattern improves.

TABLE 9. 1 Caffeine Content

Sources: Adapted from Clark (1990); Witters, Venturelli, and Hanson (1992).

Limit Alcohol

Like they turn to caffeine, people often increase their use of alcohol during periods of stress, and what begins as an attempt to cope emotionally with a problem turns out to compound the problem instead. North Americans reach for coffee to wind them up and alcohol to help them unwind. During periods of stress (and high caffeine consumption), winding down becomes more difficult. Too many people reach for a drink when they feel a need to relax. In Chapter 11 we examine the use and abuse of alcohol. For some people, a drink for the right reasons on the right occasions can be appropriate, but even moderate alcohol use can interfere with the ability to cope with stress. Many people find that even a single drink increases their fatigue and leaves them feeling groggy and less energetic the next morning. Too much alcohol greatly diminishes a person's coping ability and can lead to serious health problems (Brannon & Feist, 1992). If your alcohol use increases when you experience stress, then your drinking behavior may be problematic.

Authorities disagree about the effects of stress on a person's nutritional status. Extreme physical stress does require an increased intake of many nutrients, but does mild to moderate emotional stress also have this effect? Nutrition needs probably increase only slightly.

    Should you take a vitamin supplement? Nutritionists agree that a nutritious diet should be the primary approach to obtaining an adequate intake of vitamins and minerals. A vitamin supplement may be helpful for people who find that stress takes a toll on their eating habits. Look for a supplement that provides 100 percent of the recommended dietary allowance (RDA) for all the vitamins; a special "stress formula" is a waste of your money. And remember that a supplement can never replace all the goodness provided by food (Gussow & Thomas, 1986; Reynolds, 1994). Fiber and many other beneficial constituents of foods are absent from or present in inadequate quantities in supplements (Adler, 1995; Lipkin, 1995; Napier, 1995; Reynolds, 1994; "Scientists," 1995).

EATING IN RESPONSE TO STRESS: FEEDING THE HUNGRY HEART

Few people look on eating and food only in terms of hunger and nutrition. Every culture in the world has evolved rituals around food and eating. Feasting and fasting carry layers of religious, cultural, and emotional overtones. As children, we learn to associate food with security, comfort, love, reward, punishment, anger, restraint. It's no wonder that we eat for many reasons other than hunger: because we're lonely, angry, sad, happy, nervous, or depressed. Unlike alcohol, which we can give up if we are prone to a drinking problem, we must learn to live with food. If eating is the only way we take the time to nurture ourselves, we eat more than we are really hungry for. In extreme cases, an inability to control eating can develop into an eating disorder known as compulsive overeating, that often gets worse under stress. Compulsive overeating refers to an inability to control or stop eating, and often includes binging and rituals that involve food preparation and consumption (APA, 1994).

    If overeating is a problem, try to find other palliative coping responses that can substitute for overeating. Get in touch with your feelings of hunger and satiety; eat regular meals and snacks of healthful foods, as recommended in the section on blood sugar regulation. Eat slowly and stop eating when you start to feel full. Enjoy your food, and eat plenty of healthful carbohydrates that help you feel relaxed and less stressed. If compulsive overeating is a big problem for you, consult a qualified professional who specializes in eating problems.

BODY FAT, WEIGHT CONTROL, AND HEALTH

One of the most prevalent sources of nutrition-related stress in North America is concern about body fat and weight control (Serdula et al., 1994). Studies suggest that we should be concerned. According to the National Center for Health Statistics, one-third of the adult population in the United States is obese, judged by standard weight-for-height measures (Kuczmarski, Flegal, Campbell, &Johnson, 1994). Another cause for concern arises from obesity trends in recent years. Americans are much fatter today than they were at the turn of the century. just 15 years ago, only 25 percent of U.S. adults were considered obese; there has been a 32 percent increase in obesity in 15 years. U.S. adults weigh on average about 8 pounds more than they did 10 years ago. Obesity rates are rising in children as well. The reason appears to be our high fat consumption coupled with our sedentary lifestyle (PiSunyer, 1994). We actually consume slightly fewer calories per day than people did in the early 1900s. The problem is that we are getting more of our calories in the form of simple sugars and fats (Liebman, 1995; Ratto, 1986). We're also much less active (McGinnis, 1992).

    The weight-control issue is a complicated one for many reasons. For many people, body weight is extremely difficult to control (Brownell & Rodin, 1994). For others, attempts to diet stringently to achieve unrealistically thin physiques lead to eating disorders. Add discrimination against fat people and mountains of mediahype for worthless weight-loss schemes and products and you get, well, stress.

Is Obesity Really a Problem?

You are probably already asking questions about the meaning of the obesity prevalence statistics. An obvious question concerns the validity of obesity measures. Obesity is generally defined as weighing "too much" for a given height. Most researchers use a measure called the Body Mass Index (BMI) to define obesity. Body Mass Index is calculated by dividing weight in kilograms by height in meters squared (kg/m2). Nonmetric readers can calculate BMI by multiplying a person's weight in pounds by 700, then dividing the result by the square of height in inches. Charts are also available (see Table 9.2). BMIs from 20 to 26 are considered safe. For men, a BMI greater than 27.8 is considered obese; a BMI greater than 27.3 is considered obese for women. BMIs can be misleading since they do not take into account the true variable of interest: body composition, the proportion of your body that is fat. Many athletes, for example, are "too heavy" according to their BMIs when in reality they are simply large and muscular. Unfortunately, body composition estimates are very hard to get for large groups of people, so we are stuck with height-weight measures such as BMI in most studies. Because people who are muscular and active represent a fairly small proportion of the North American population, statistics showing an increasing weight for U.S. adults probably indicate increasing fatness rather than increasing muscularity.

    Another interesting point is that although U.S. adults have become fatter, their health has actually improved somewhat. Our rates of heart disease are declining despite our increase in obesity. Opponents of this argument point out that many studies have found associations between excess body weight and health problems for both men and women, including hypertension, high cholesterol levels, type 11 diabetes, atherosclerosis, certain cancers, arthritis, gallstones, and lower back problems (Pi-Sunyer, 1993). Risk for these problems increases in a dose-response fashion: the greater the excess weight, the greater is the risk. The typical middle-age weight gain of 20 or 30 pounds experienced by many North Americans appears to increase their health risk. One study found that women who added 22 to 40 pounds after age 18 had a 70 percent greater risk of death from heart disease and a 20 percent greater risk of cancer than women who had maintained their weight (Manson et al., 1995).

TABLE 9.2 Body Mass index According to Height (in inches) and Weight (in pounds)

Source: Table derived from BMI calculations.

    Is obesity the real culprit for these increased risks, or is obesity simply a marker for other lifestyle factors that represent the real risk, such as a sedentary lifestyle and poor eating habits? Some experts believe that excess body fat probably interacts with heredity and lifestyle to affect metabolic processes such as blood sugar regulation that are associated with health risk. Some studies have found that improving diet and starting to exercise improve health even in the absence of any weight loss (Brownell & Rodin, 1994). In other words, obesity with normal blood pressure, cholesterol, and good blood sugar control may not be so harmful to your health if you exercise and eat a nutritious, low-fat diet (Gaesser, 1996).

Studies of large groups of people can suggest weight guidelines, but it is hard to say how fat is too fat for any given individual. In addition to calculating BMI several factors, discussed next, should be considered.

Body Composition As mentioned above, weight for height may not represent obesity. The scale does not lie, but it does not tell the whole truth, either. If you are big and muscular, you may be too heavy according to the charts but still have a healthy body composition. Body composition can be estimated in several ways, all requiring special equipment. Healthy body fat levels for men range from about 12 percent to 20 percent, with athletes as low as 5 percent. Women should be about 20 percent to 30 percent fat, although female athletes may be 16 percent or less. Like weight, we really do not know exactly what percentage of fat becomes a health risk for any given individual.

Location of Fat Stores Another problem with height-weight tables is that all fat stores are not created equal. Obesity-related health problems are much more likely to occur if extra fat is stored on the torso rather than on the hips and thighs (Campaigne, 1990; Despres et al., 1988). Lower- body obesity is still a health risk, however; people with "pear shapes" are at higher risk for obesity-related disorders than people who are not overweight.

Medical History and Family Medical History Weight control or at least healthful exercise and eating habits are especially beneficial for people who have obesity-related health problems, such as hypertension, high blood cholesterol, type II diabetes, artery disease, or a family history of these disorders.

Age People who are over 70 years old and a bit overweight but apparently healthy probably need not be concerned about losing weight. In the absence of medical indications for weight control, many nutritionists recommend an extra 10 or 15 pounds for people over 70 to help them resist wasting if they should become ill. And if the extra weight is not associated with health risks, losing weight will probably offer them no health benefits.

Too many studies suggest that dieting for many people is not only futile but harmful to their health (Lissner et al., 1991; Rodin, Radke-Sharpe, Rebuffe-Scrive, & Greenwood, 1990; Wadden, 1992). Frequent dieting interspersed with periods of normal or greater-than-normal caloric intake are common in people attempting to lose weight. Those who are eating this way may lose and regain the same 20 or 30 pounds many times, a process known as weight cycling. Weight cycling appears to have several harmful side effects, including increased risk of the dieter's developing hypertension, artery disease, and gallbladder disease (Brownell & Rodin, 1994; Lissner et al., 1991). Some of the negative health effects may be explained by the observation that many people who regain weight lost on a diet use progressively less healthful weight control methods (fasting, vomiting, diet pills) on subsequent weight loss attempts (Zimmerman & Hoerr, 1995). Research suggests that moderately obese people who don't try to lose weight are healthier than obese people who have experienced frequent fluctuations in body weight (Gaesser, 1996).

    Trying to lose weight can be a frustrating experience that creates more stress, more cravings, and ironically, more obesity (Wooley & Garner, 1991). When attempts to lose weight are unsuccessful, dieters blame themselves rather than the diet. Instead of trying to achieve a specific weight-loss goal, people who are overweight are advised to focus on long-term lifestyle improvement: increasing physical activity, managing stress, and developing healthful eating habits. When lifestyle changes, some weight loss may occur. Slow, steady weight loss is more likely to be permanent and less likely to lead to obsessions with food and weight than is fad dieting. The first 10 to 15 pounds of weight loss can dramatically improve health factors such as blood sugar control and blood lipid profile. In other words, if you are quite a bit overweight, you need not struggle to achieve an unrealistically low weight to improve your health. Best of all, the lifestyle changes that improve your health improve your stress resistance as well!

    People who think they are overweight often put their lives on hold: I'll do it after I've lost 20 pounds. "It" may be to end an unhappy relationship, look for a better job, or pursue some other interesting goal. Unfortunately, the 20 pounds remain and long-term goals are put on permanent hold. Recommendations for lifestyle change will work only if you can still love yourself and enjoy life. Change must always come from a desire to be good to yourself because you are worthy of the best treatment.

Compulsive Dieting and Disordered Eating

Our culture has discovered the perfect recipe for the development of eating problems: combine an abundant food supply rich in fat with sedentary occupations, and then establish an unrealistic standard of thinness by which to judge self-worth. Problems with food and body image run the gamut from occasional dieting, eating binges, and some concern about being overweight, to constant worry about food and weight, to the clinical eating disorders anorexia nervosa, bulimia nervosa (see Figure 9.3), and compulsive overeating, which may become life threatening and involve serious psychological problems. The term disordered eating refers to this continuum of problems with food and body image (see Figure 9.4).

FIGURE 9.3 Definitions of Anorexia Nervosa and Bulimia Nervosa
Source: Diagnostic and Statistics Manual for Mental Disorders, 4th ed. DSM IV. American Psychiatric Association.

    At an extremely early age, children, especially girls, begin to worry about how they look and they begin to diet ("Body-weight," 1991; Brownell, 1991). The weight-loss industry promotes many misconceptions about food and weight, and vulnerable young girls accept and value these myths. Many adults buy into these myths as well. Advertisements imply, for example, that fatness is shameful, an indication of sloth and gluttony. The attainment of a thin physique, on the other hand, means virtue and self-control. Thinness is equated not only with beauty but with success, love, and happiness. Fat is bad; thin is good. The other myth is that with enough willpower, and perhaps the right products, we can achieve the superslender bodies we see in magazines. We are led to believe that only self-control stands between the bodies we have now and the magnificent specimens we could become.

FIGURE 9.4 Disordered Eating Continuum

    Many people trying to lose weight focus on some form of very low-calorie diet (VLCD), commonly and appropriately known as a crash diet. Such diets are both ineffective and harmful to one's long-term health and stress resistance. They rarely educate the dieter about prudent food choices, so once the diet is over, the dieter usually gains back all the weight lost on the diet, and then some (Bouchard et al., 1990; Brownell et al., 1986; Pavlou, Krey, & Steffee, 1989). Very low-calorie diets often leave the dieter feeling deprived, depressed, and tired. They commonly lead to powerful food cravings, which in turn lead to binges. Binging is followed by guilt, even stricter dieting, greater cravings, and more misery. Sometimes this harmful pattern evolves into a full-fledged eating disorder, especially in people who are psychologically vulnerable to such problems (Brehm & Keller, 1990; WorthingtonRoberts, 1990).

    Many of us are careful about what we eat and watch our weight because we want to stay healthy and feel good. Unfortunately, this healthy concern can turn into an unhealthy preoccupation with food and weight. Over 50 percent of people who claim they are dieting to lose weight are not overweight (Ornstein & Sobel, 1989). Social commentator Jean Kilbourne notes that one of the greatest problems associated with our society's preoccupation with food and weight is "the impoverishment of the imagination" (Kilbourne, 1995). Many people, especially women, spend their days counting calories or grams of fat, and thinking about what they will have for their next meal. Others are so concerned about ensuring food purity, avoiding carcinogenic additives, or following the perfect eating plan to prevent health problems such as artery disease or cancer that they worry about every morsel they consume. Eating becomes a cognitive act unconnected to appetite and enjoyment, and all food is potential poison.

EAT, DRINK, AND BE MERRY

Food should be enjoyed and eating meals should be a pleasurable experience. Why not? Healthy pleasures increase your stress resistance, as you will see in Chapter 11. Relaxed, enjoyable mealtimes improve the function of your digestive system (which works best when the parasympathetic nervous system is in gear). Try really to taste and enjoy your food. Take a deep breath before you begin your next meal and tune in to the tastes and smells before you. Focus the conversation on pleasant topics. Eating slowly is a treat; the extra ten minutes spent at the table can provide an island of pleasure in a hectic day.

Evaluating and changing your eating habits is a lifelong process that requires a realistic, one-step- at-a-time approach (Brownell & Cohen, 1995). Small changes you can live with do more good than dramatic overhauls that drive you crazy and last only a few weeks. Anticipate setbacks and don't despair if your plans don't always work perfectly. Learn from the difficulties and adjust your plans accordingly. Most of all, enjoy your food and appreciate your progress. Use the action plan worksheet on the next page to help increase the stress resistance of your diet.

Decide what you are already doing well and what habits could use some improvement. Perhaps you have a nutritious breakfast but the day starts to fall apart by noon, so you grab some high- fat fast food for lunch and a pizza for dinner. Use your problem-solving skills to define your nutrition problem areas and brainstorm some solutions. Some people find it helpful to record their food intake for three or more days. A dietitian or nutritionist can help you assess your diet and suggest appropriate changes. Consulting such a specialist is especially useful if you are pregnant or have health concerns such as food allergies, diabetes, high blood cholesterol, or high blood pressure. Once you have a good idea of the meals that need the most help, you can start to plan ahead.

Decide how to deal with problems that keep you from eating a more nutritious diet. One stress management student who cooked for her family found that dinner was too often fast food or high- fat snacks rather than a nutritious, low-fat meal. This was because the dinner hour was a difficult time. She would get home from work and school with little energy left for preparing dinner and spending time with her family. She solved this problem by beginning dinner preparations in the morning before she left the house. Everything was ready to go when she got home so dinner preparation was minimal, tensions were lower, and the family dinner hour was much less stressful. Meals were better planned and more healthful as well.

    If you find you are missing dining hall hours, figure out a way to make a nutritious alternative available. If a twice-a-day dessert habit is getting in the way of weight control, make a plan for occasional desserts and for low-fat dessert replacements. When you go grocery shopping, always have a list and avoid impulse buying. Stick to your list and just say no to junk food.

    Make a list of nutritious food you want to have on hand for snacking and meals. We often eat high-fat or empty-calorie foods because we're hungry and reach for the nearest alternative. If you make healthful foods convenient, you'll avoid impulse snacking on high-fat foods and make healthful choices a habit.

    If you are in a household that prepares meals, a weekly menu plan saves time and improves meal quality. Plan meals for the upcoming week and shop for the necessary ingredients. Trying to pull a meal together at the end of a busy day can be stressful and fast food every night becomes your coping response. To improve your stress resistance, following a nutritious diet must be as stress free as possible. Organization is the key. The time you spend planning once a week will save the time and stress of last-minute shopping and help you stick to your good intentions.

SUMMARY

1. Good nutrition improves both short-term and long-term stress resistance.

2. Overnutrition, the consumption of too much fat and sugar and too many calories, is the most common nutrition problem in North America.

3. Nutrients are classified into six groups. Carbohydrates supply energy. Protein is used by the body for many structures and metabolic functions; it also supplies some energy. Lipids include dietary fats and oils and are a concentrated source of energy. Vitamins and minerals are required for growth, development, energy production, structural components of the body, and countless metabolic functions. Water is important for many functions, including digestion, transportation of nutrients and wastes, and temperature regulation.

4. Fatigue and irritability result when blood sugar level gets too low. To maintain an even level of blood sugar, eat regularly, consume some protein at every meal, and avoid sugar overload.

5. Blood sugar level is regulated by two important hormones. Insulin is released in response to high blood sugar levels. It allows the sugar (glucose) to leave the blood and enter the cells of the body. Glucagon is released in response to low blood sugar levels. It stimulates the release of glucose from precursors such as glycogen and amino acids.

6. Mood and energy level are partly a function of neurotransmitter activity in the central nervous system. Neurotransmitter activity is partially dependent on diet. High-protein foods consumed with or without carbohydrate are associated with elevated levels of dopamine and norepinephrine, which help you feel alert. Carbohydrate meals. are associated with elevated levels of serotonin, which makes you feel sleepy and relaxed.

7. Guidelines for a healthful diet include the following: eat more fruits, vegetables, and grains; limit fat, sugar, and salt intake; drink plenty of fluids; limit caffeine; and limit alcohol.

8. Caffeine is a sympathomimetic substance, which means its effects mimic those of the sympathetic nervous system and thus cause the fight-or-flight response. If you add caffeine to an already aroused sympathetic nervous system, the results can be stressful.

9. The need for vitamins and minerals seems to increase only slightly when people are under emotional stress. Supplements may be helpful for people with poor eating habits but can never replace all the benefits derived from a healthful diet.

10. Compulsive overeating is an eating disorder characterized by the inability to control or stop eating; it often includes binging and rituals that involve food preparation and consumption. Compulsive overeating often worsens with an increase in stress.

11. About one-third of adults in the United States are obese. The reasons for our high rates of obesity appear to be our high fat consumption coupled with our sedentary lifestyle.

12. Body composition estimates indicate what percentage of your body is composed of fat.

13. Obesity has been linked to a number of physiological disorders, including diabetes, hypertension, artery disease, gallbladder disease, high cholesterol levels, certain cancers, arthritis, and low-back problems. Some experts believe that the poor diet and inactivity that often accompany obesity may be partly to blame for some of these disorders.

14. A Body Mass Index of 20-26 is generally considered healthy. People deciding whether to try to lose weight should consider other variables as well, including body composition, location of fat stores, medical history, family medical history, and age.

15. Weight cycling refers to repeatedly losing and regaining weight. Weight cycling increases risk for hypertension, artery disease, and gallbladder disease. Slow, steady weight loss is much more healthful, even if only a relatively small amount of weight loss occurs.

16. Frequent attempts to lose weight can result in disordered eating behaviors, such as following very low-calorie diets (VLCDs) and fasting to lose weight. Very low-calorie diets are ineffective and harmful to one's long-term health and stress resistance.

17. Anorexia nervosa is a clinical eating disorder characterized by an extremely low body weight and an intense fear of becoming fat.

18. Bulimia nervosa is a clinical eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

19. Food should be enjoyed, and eating meals should be a pleasurable experience.

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