Wellness, Growth, and Development

Chapter 8


Wellness, Growth, and Development



Learning Objectives



image Define at least 10 terms relating to wellness, growth, and development.


image List at least three factors that may be used to determine a level of wellness.


image Describe three categories of disease prevention.


image List the function of each of the five nutrients.


image Construct a personalized U.S. Department of Agriculture (USDA) food pyramid and number of recommended daily servings for each category.


image Describe the relationship of calories to weight loss and gain.


image Describe at least five types of therapeutic diets used to meet individual nutritional needs.


image Identify at least five events that may lead to a reaction of stress.


image Describe at least five health conditions that may result from stress.


image Describe at least four methods that may be used to manage stress.


image Compare the physical development of the body through the life span.


image Describe the psychosocial development through the life span.


image Describe two models of change theory that may be applied to health care behavior.


image Describe each of the five stages of death acceptance (grief).



Key Terms


















Wellness


Wellness may be defined as a state of health on a continuum from a level of high energy and feeling of well-being to illness or death. Optimal wellness reflects a balanced relationship among the individual’s physical, mental, and social health. Wellness is determined by the lifestyle choices a person makes. These choices include the amount of sleep, type of diet, exercise plan, personal habits, social relationships with others, and so forth. Many models have been designed to describe the type of lifestyle and personal habits that promote wellness, interrelating the body, mind, and spirit (Fig. 8-1). The body refers to physical health and development. The mind refers to intellectual and emotional development. The spirit includes inner and personal reflection.


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FIGURE 8-1 This model details different descriptors necessary for wellness.

Fitness may be evaluated by considering muscle strength and endurance, cardiorespiratory endurance, body composition, and flexibility. Some indicators that may be measured to evaluate optimal physical fitness include the following:



Some of the laboratory blood tests that may be used to indicate levels of wellness include the following:



An optimal state of wellness emphasizes self-care, personal responsibility, prevention of illness, and management of health through lifestyle choices. Concepts that may improve wellness include nutrition, stress reduction, counseling, habit cessation, and exercise.



Prevention


Preventative medicine includes the methods used to prevent disease in people instead of curing it. It can be classified into three categories, including primary, secondary, and tertiary prevention.


Primary prevention includes methods that are specifically directed toward a particular disease, such as immunizations or general interventions such as education. It is intended to protect the whole population. Primary prevention may be called health promotion. An example of health promotion would be regular exercise.


Secondary prevention is directed toward individuals who have risk factors for disease but have not yet developed it. It is intended to detect disease as early as possible. Examples of secondary prevention would be having regular mammograms to detect breast cancer and treatment of injuries to prevent infection.


Tertiary prevention includes the steps taken to minimize the disease when primary and secondary prevention have failed. It is designed to limit disability and rehabilitate the individual with disease. An example of tertiary prevention is the monitoring of medication and therapy in someone who has suffered a heart attack (Box 8-1).



BOX 8-1   Heart Health Prevention Categories





Nutrition


Nutrients


Metabolism refers to the physical and chemical processes that produce energy. The energy used by the body for growth and activity comes from the food that is eaten. Body cells metabolize or process food in two ways. Anabolism is the process of building tissues from small compounds, and it requires energy to occur. Catabolism is the breaking down of tissues into materials that may be reused or excreted. Catabolism releases energy that may be used for other activities of the cell.


Nutrition is the study of the food that is eaten and how it is used in the body. Nutrients are chemical materials in food and are vital to the body functions. Good nutrition is important in maintaining the best health possible.


Five nutrients have been identified as being essential to the maintenance of good health. They are carbohydrates, proteins, fats, vitamins, and minerals. Additionally, the body’s cells need sufficient water to metabolize these nutrients. Effective use of one nutrient depends on the presence of all of the other nutrients in the body.


Since May 1994 all producers of processed foods have been required to comply with the Nutrition Labeling and Education Act. Labels on foods must be consistent and meet guidelines set by the U.S. Food and Drug Administration (FDA). Figure 8-2 lists the contents of processed food that must appear on the label. Additionally, foods that make health claims such as “low in …,” “good source of …,” or “lean” must meet specific guidelines for these statements, and claims can be made in only seven categories.


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FIGURE 8-2 Food labels provide nutritional information that reflects the content of the food.

The FDA developed the reference daily intake (RDI), which indicates the nutrient value of processed foods and supplements. It replaced the term recommended daily allowance (RDA), which was previously used for labeling.


RDI (RDA) now indicates the amount of nutrients that should be consumed daily to meet the nutritional needs of almost all healthy people. The National Research Council committee establishes the RDI (RDA) guidelines. The committee, made up of nutritional scientists, has been providing these estimates since 1934 and revises its recommendations every 5 years.


Carbohydrates are found in all plants that are used as food sources. Carbohydrates are the main source of quick or immediate energy used by the body. Sugar and starch are the two main forms of carbohydrate. Foods that provide carbohydrates include cereal, potatoes, dried beans, corn, bread, and sugar. Carbohydrates found in fruit and vegetables also provide fiber or bulk to help with elimination of wastes. Carbohydrates also are necessary to use fat. If carbohydrates are not present in the diet, proteins are used as the alternate energy source.


Proteins are found in food from animal sources such as eggs, milk, meat, fish, and poultry. Additionally, dried beans, peas, and cheese provide this nutrient. Protein contains the compounds (amino acids) necessary to build muscle, bone, blood, and antibodies. Strict vegetarians who do not eat eggs or milk may combine legumes and whole grain products such as red beans and rice to obtain the nine essential amino acids. Amino acids that are called essential cannot be synthesized from other food sources.


Fats are found in the marbling or white part of meat, cooking oils, salad dressings, and in some milk products such as butter. Fat provides the most concentrated form of energy. Fat is necessary to repair cells and make hormones. Fats also supply essential fatty acids and fat-soluble vitamins. Fats are classified as saturated or unsaturated. Saturated fats are found in animal products and are solid at room temperature. Unsaturated fats are found primarily in vegetables and contain less cholesterol than saturated fats. Cholesterol is a waxy compound found in fats and is produced by the body. It is used by the brain to transmit nerve impulses and forms part of cell membranes. Cholesterol is necessary in the skin to produce vitamin D and is used in formation of bile acids and reproductive hormones. Cholesterol is sticky and may be deposited in the walls of blood vessels when too high a level accumulates in the blood. Because high cholesterol levels are linked to heart disease, unsaturated fats are believed to produce fewer health risks than saturated fats.


Vitamins are organic compounds that regulate cell metabolism. Each vitamin has specific functions (see Appendix: Vitamins and Minerals on Evolve). Vitamins are divided into two groups depending on whether they dissolve in water or fat. Vitamin supplements are not necessary if a varied and balanced diet, which contains all the nutrients, is eaten. Vitamins, especially vitamin C, may be destroyed when overcooked.


Minerals are simple compounds that regulate body processes. Nineteen minerals are used by the body. Seventeen are considered to be essential (see Appendix: Vitamins and Minerals on Evolve). Minerals are found in many food sources. Ten times the recommended daily allowance of vitamins and minerals is considered to be an overdose, or megadose (Table 8-1).




Food Groups


In June 2005 the USDA replaced the food group pyramid designed to help plan meals that provide all of the nutrients needed in a daily diet (Fig. 8-3). The new pyramid, called MyPyramid, provides an opportunity to personalize the plan for healthy eating and exercise. A healthy diet includes all of the recommended food groups to provide all of the required nutrients. The food groups include milk, meats and beans, vegetables, fruits, and grains. Servings of oils are not considered a food group because they contain calories but no nutrients. Additionally, they are found in a natural form in many other foods.


image
FIGURE 8-3 The food pyramid is used as a guide to provide a balanced diet. (From http://www.mypyramid.gov.)

The new pyramid uses a symbol that includes all of the parts of healthy eating and physical activity. It includes activity, moderation, personalization, proportionality, variety, and gradual improvement. The pyramid calculates dietary information on the basis of age, gender, and levels of activity (Table 8-2). The plan includes tips to improve nutrition such as including calcium-rich foods, choosing lean proteins, varying vegetable selections, choosing whole grains, and focusing on fruits and physical activity. The flexibility of the plan provides alternatives to meet dietary needs due to religious, cultural, or health preferences.



The average person in the United States consumes 493 cans of soft drinks and 56 kg (123 lb) of sugar a year. Although the recommended daily allowance of salt is 2200 mg, or about 1 teaspoon, most people in the United States consume two to four times that amount. Most people in the United States could improve their nutrition by reducing their intake of fat, sugar, and salt. The amount of fruits and vegetables should be increased. Through adolescence, about 1 quart of milk daily is necessary to supply the minerals necessary for bone growth.



Calories


Another method used to measure the amount of food necessary to perform the body functions is counting calories. A calorie is the measurement of the amount of energy needed to raise 1 g of water 1° C. The amount of calories necessary daily depends on gender, age, size, general condition, and daily activity. In general, the caloric need can be estimated by multiplying the desired weight in pounds by 15 calories per pound per day (Box 8-2). A balanced diet provides 15% of the calories from protein sources. Fat sources should provide 30% of the daily calories, with the remaining 55% provided by carbohydrates.



BOX 8-2   Estimating Caloric Needs




Body mass index (BMI) is a number that is calculated using a person’s weight and height. It indicates the amount of body fat and is used to screen for health problems. Although it does not measure the amount of fat directly, the results have been shown to correlate with measurements made using techniques like measuring skinfold thickness with callipers and hydrostatic (underwater) weighing. The BMI for adults (20 years or older) is calculated using a standard formula for men and women (Box 8-3).



BOX 8-3   Body Mass Index Status*
















Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and greater Obese


*Formula: weight (lb) / [height (in)]2 × 703.


For children and teens under 20 years of age, the BMI is specific for age and gender. This is because the amount of fat changes with age and differs between girls and boys during growth years. The BMI status in children and teens is considered a screening tool, not a diagnostic tool. The CDC provides BMI-for-age growth or status charts for use with children and teens (Box 8-4).



BOX 8-4   Body Mass Index Weight Status Percentile Range for Children and Teens*
















Underweight Less than the 5th percentile
Healthy weight 5th percentile to less than the 85th percentile
Overweight 85th to less than the 95th percentile
Obese Equal to or greater than the 95th percentile


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*From the Centers for Disease Control (CDC), available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.html.



image Brain Byte


According to the CDC, more than a third of adults and 16% to 33% of children in the United States are obese.


Weight can be regulated by counting calories. One pound (0.45 kg) of fat tissue is the equivalent of 3500 calories. Carbohydrates and protein provide 4 calories per gram. Fat provides 9 calories per gram. Vitamins and minerals do not contain any calories. Fad diets that limit the variety of foods eaten usually do not work on a permanent basis. One reason that quick weight loss is unsuccessful is that the body, when deprived of the essential nutrients, stores additional energy in the form of fat. Controlling weight results from balancing the number of calories taken in and the number of calories used as energy. The most successful method of weight loss is a gradual increase in caloric output by additional exercise and a decrease in the caloric intake of food. Weight loss of 1 to 2 pounds per week is considered safe and effective (Fig. 8-4).


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FIGURE 8-4 Simple changes in daily activities can increase exercise and the number of calories used. (Photo courtesy of National Health Occupations Students of America, Flower Mound, Tex.)


image Brain Byte


Eating 500 calories less each day results in 1 lb of weight loss each week.





Diet Therapy


Special diets are used to treat specific health conditions (Table 8-3). In addition to providing a balanced diet with adequate calories, the needs of special populations must be considered. Food habits are influenced by nationality, race, culture, religious beliefs, and personal preferences. Special diets must consider these factors, as well as nutrient requirements. The Dietary Guidelines for Americans (USDA, 2005) provide guidelines for older adults. A list of warning signs has been developed as a nutritional health checklist using the word DETERMINE (Box 8-5).



BOX 8-5   Nutritional Health Checklist




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Apr 15, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Wellness, Growth, and Development

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