Physician Heal Thyself? Get Psyched for Zestful Dietary/Exercise/Lifestyle Stratagems in Your Busy Life

Physician Heal Thyself?

Presented as a workshop at WELL-Med International ConferenceAlexandroupolis, Greece—28 May 2014

Get Psyched for Zestful

Dietary/Exercise/Lifestyle Strategems in

Your Busy Life!Robin Lynn Treptow, PhD

[email protected]

1.Name2.Country3.Profession4.Why came to this workshop?


…a tutorial to help physicians …Physician Heal Thyself?

Healthy Physicians—“Do What I Do!”

1. Understand motivators for & barriers to healthy behavior

2. Change negative, hopeless, or unproductive health

thoughts 3. Employ psychological tools

to make positive health choicesConcrete take-home tasks

Understand motivators

for & barriers to healthy behavior

—construed broadly as preventing or treating

acute or chronic diseases…”American Medical Association (2004). Ethics Opinion 9.0305—Physician Health

& Wellness. Based on the report “Physician Health & Wellness” adopted December 2003. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion90305.page

responsibility

“to preserve the quality of their

performance, physicians have a

to maintain their

health & wellness

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion90305.page


“If we could give every individual the right amount of nourishment & exercise, not too much & not too little, we would have found the safest way to

health.”

Hippocrates—c. 460 – c. 370 BC

Hippocrates, trans. WHS Jones. Harvard University Press, 1923.

right amount of nourishmen

t & exercisesafest way to health

•Physical discomfort•Diabetes

•Body composition•Cardiovascular health•Musculoskeletal health

•Mental health•Activities of daily living

Exercise’s benefits1

1Westcott, W. L. & La Rosa Loud, R. (2013). Enhancing resistance training results with protein/carbohydrate supplementation. American College of Sports Medicine’s Health & Fitness Journal, 17(2), 10-15.

•Skeletal muscle •Tendons & connective

tissue •Joints

•Cardiovascular•Skeletal

•Mental health•Metabolic

Exercise’s benefits1

1Fentem, P. H. (1994). Benefits of exercise in health & disease. British Journal of Medicine, 308, 1291-1295.

NationalCancer Institutehttp://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivityhttp://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants

AMERICAN HEART ASSOCIATIONhttp://www.heart.org/HEARTORG/GettingHealthy/Diet-and-LifestyleRecommendations_UCM_305855_Article.jsp

American Diabetes Association http://www.diabetes.org/living-with-diabetes/complications/mens-health/diet-and-exercise/

American Cancer Society http://www.cancer.org/healthy/eathealthygetactive/

acsguidelinesonnutritionphysicalactivityforcancerprevention/nupa-guidelines-toc

The Mayo Clinicwww.mayoclinic.com/health/mayo-clinic-diet/my01646

The World Health Organizationhttp://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

http://www.who.int/dietphysicalactivity/diet/en/


http://www.cancer.org/healthy/eathealthygetactive/

“Healthy eating may be best achieved with a

plant-based diet, which we define

as a regimen that encourages whole, plant-

based foods & discourages meats, dairyproducts, & eggs as well

as all refined & processed foods.”


Tuso, P. J., Ismail, M. H., Ha, B. P., & Bartolotto, C. (2013). Nutritional update for physicians: Plant-based diets. The Permanente Journal, 17(2), 61-65. Retrieved on 23 May 2014 from http://dx.doi.org/10.7812/TPP/12-085

“Primary care clinicians & office staff are resistant to

health behavior change. External motivation did not

seem to help them change.” (p. 694)

Erskine, J., Lanigan, A., Emsermann, C. B., Manning, B. K., Staton, E. W., & Pace. W. D. (2012). Use of the Americans in Motion-Healthy Intervention (AIM-HI) to create a culture of fitness in family practice. J Am Fam Med, 25, 694-700.

MOTIVATORKnowledge base

BARRIERJob demands

(e.g., long hours, stressful work conditions)

“The main treatment for obesity is lifestyle & behavior

modification.”1male physicians (no published data on females)

•44% are overweight & 6% are obese.

female nurses (in the United States)

•28% are overweight & 11% are obese.

1Reilly, M. J. (2007). Are obese physicians effective at providing healthy lifestyle counseling? Am Fam Physician, 75(5):738-741. Retrieved on 17 May 2014 from http://www.aafp.org/afp/2007/0301/p738.html.

http://www.aafp.org/afp/2007/0301/p738.html

ExerciseWater

& other low-sugar

drinksFruits, vegetables, & whole grains

Healthy Breakfast


Tucker, C. M.,…Desmond, F. F. (2011). Development of the Motivators of & Barriers to Health-Smart Behaviors Inventory. Psychological Assessment, 23(2), 487-503. doi:10.1037/a0022299



…eat a HEALTHY BREAKFAST!

LOTS of fruits & vegetables!



100% WHOLE GRAIN

breads, pastas, &cereals!



Drink ONLY

WATER & other drinks low in sugar!



18

DAILY EXERCISE

30 minutes adults60 minutes children


World Health Orgamozatopm. (2014). Global strategy on diet, physical activity, & health: Physical activity & adults. http://www.who.int/dietphysicalactivity/factsheet_adults/en/

ExerciseWater

& other low-sugar


Healthy Breakfast



Healthy breakfast—Motivators1) I am trying to lose weight& I

think eating a healthy breakfast each morning will help.

1= strongly disagree; 2 = disagree; 3 = agree; 4 = strongly agree

2) I think you have to eat breakfast if you want to be healthy.

3) It is my job as a role model for my kids or for someone else important in my life.

4) I think that eating a healthy breakfast will keep me from getting diseases. 5) I want to have a healthy body weight: & I think eating a healthy breakfast is better for that than skipping breakfast.6) I think about how I might feel hungry or bad later if I do not eat breakfast.

7) It is one way that I keep myself healthy.

8) If I want healthy breakfast foods, I can get them.9) I have time to eat breakfast

if I want to.10) When someone else makes me a healthy breakfast, I eat it.

11) I always ate a healthy breakfast as a child.

12) Other people in my family eat a healthy breakfast.

13) Growing up, my parents told me about the importance of eating a healthy breakfast.

14) Healthy breakfast foods are the foods I am used to eating.

Tucker, C. M.,…Desmond, F. F., (2011).

Healthy breakfast—Barriers

1) My culture's traditional breakfast foods are not very healthy.


2) I cannot tell which cereals are the healthy ones.

3) I am confused about which breakfast foods are healthy & which are not.

4) I want to eat something sweet in the morning.

5) Other people in my family usually do not eat a healthy breakfast.

6) I would rather sleep late & skip breakfast.

7) I do not have time to get ready in morning & also eat a healthy breakfast.

8) To me, "eating a healthy breakfast" means taking a long time to prepare something.


Healthy food & snacks—Motivators1) Eating healthy foods is

part of my regular routine.


2) I eat healthy every day so that I can be healthy.

3) I have the discipline to eat healthy.4) I have a personal goal of eating healthier snacks.

5) I like the taste of most fruits & vegetables.

6) Fruits & vegetables (fresh or frozen) are usually available in my home.7) I like to add variety to

what I eat by trying new fruits & vegetables.8) Eating healthy foods & snacks helps me look good.

9) Eating healthy foods keeps my body in shape.

10) Someone has taught me why fruits & vegetables are healthy.

11) Eating healthy foods helps me to be physically active.

12) I am concerned about preventing diabetes.

13) I am concerned about preventing high blood pressure. 14) I am concerned about preventing high cholesterol.

15) I have a health or medical condition & need to eat healthy because of it.16) I can find healthy snacks that come in small packages.

17) There are healthy options at most restaurants that I go to.18) Healthy snacks come in small packages that help me not eat too much.


Healthy food & snacks—Barriers1) I just do not care about

eating fruits & vegetables every day.


2) I do not like the taste of most vegetables.

3) when I go to the grocery store, I do not specifically think about buying fruits & vegetables.4) I just do not care about eating healthy every day.

5) When I buy or make a meal, I just do not think about whether or not it has fruits or vegetables in it.6) I do not look or feel any different when I eat healthy.

7) Fresh healthy foods are not easily available.

8) I cannot get healthy snacks in the snack machines.

9) Healthy foods are not easy to find at restaurants.

10) I get cravings for unhealthy foods.

11) I crave sweets or junk food instead of fruit as a snack.

12) When someone cooks or gives me unhealthy food, I eat it.

13) When there are unhealthy foods at home, it is hard to choose healthy foods.


Healthy drinks—Motivators1) Water tastes better than most

other drinks.


2) It is more satisfying to drink water while I eat than any other drink.3) Each day, I think about making sure I drink enough water.4) I like how water tastes.

5) I have a habit of carrying water with me when I go places.6) When I exercise or play sports, I drink only healthy drinks.7) I do not want to spend money on other drinks when I can get water for free.8) On days when I am active, I choose healthier drinks.

9) My friends drink mostly water & other healthy drinks.

10) Drinking water keeps me from having stomach or bowel problems.11) My doctor encourages me to drink water & healthy drinks.12) I have a medical or health problem, & it helps to drink water (or I have been told that it will).13) Drinking soda makes me feel even thirstier.

14) When I choose what to drink, I think about whether or not it is healthy.15) I do not want to have drinks with a lot of sugar in them.

16) I read the nutritional facts to see what is in a drink before I decide if I want to buy it.


Healthy drinks—Barriers1) We usually have regular

soda (not diet) in the refrigerator at home.


2) Drinking sugary drinks is a habit for me.

3) I like the taste of regular soda but not diet soda.

4) Seeing commercials for sodas makes me want to drink them.

5) I do not understand why water is healthy.

6) I am confused about whether drinking a lot of water will make me gain or lose weight.

7) I do not know how to tell the difference between 100% juice & juice with sugar added.8) I do not drink a lot of water because it makes me feel bloated.

9) I am confused about whether or not diet sodas are bad for me.10) I am confused about some of the sugar substitutes that are in diet drinks.

11) Healthy drinks cost more than unhealthy drinks.

12) Healthy drinks are not often in vending machines ("drink machines")..

13) Bottled water is too expensive for me to buy.


Physical activity—Motivators1) I think being active is

something fun & enjoyable to do.


2) It does not have to cost anything for me to be physically active.3) I can get exercise from a variety of activities.

4) I think it is important to stay active at my age.

5) I can make the time to exercise.6) It is easier to be active after I have gotten enough sleep.7) I do not have time to watch TV.8) I do not have cable TV, so I do more active things instead of watching TV.9) I have to be active to take care of a pet.10) I have to walk to get where I need to go.11) I only watch TV at night, so I can do other more active things during the day.12) Sometimes I like to try doing activities that I see on TV, like on a sports show or an aerobics show.

13) I want to be able to do more difficult physical activities (like run farther or lift more weight). 14) Being active makes me attractive to others.

15) I listen to music while I exercise.16) I try to find simple ways to get more exercise, like taking the stairs instead of the elevator.

17) I have somewhere safe to go walking or be physically active. 18) There is no special equipment required to do some of the activities that I like to do. 19) I have to be active because of a medical or health condition that I have. 20) I have a medical or health condition that exercising is supposed to help. 21) My doctor says that I need to be more active for my health.

22) My doctor has told me that my risk of death/disease is greater if I do not exercise. Tucker, C. M.,…Desmond, F. F., (2011).

Physical activity—Barriers1) I would rather watch TV or

play video games than do something active.


2) Watching TV or playing video games is more fun than doing something active.3) TV, movies, or video games let me take my mind off of other things better than exercising does.4) TV, movies, or video games are better ways to relax than exercising.5) I would rather watch TV than be active because it is easier.6) Watching TV relieves my stress better than exercising.7) I have a hard time making myself turn off the TV to do something active.8) At my age, I think it is okay to watch TV instead of being active.9) I do not like to walk unless I have to.

10) I have a health conditions that stops me from being more active.

13) I have asthma or a similar condition that makes it hard to breathe when I exercise.

14) I cannot afford a gym membership.15) I do not have the equipment I need to be able to exercise.

11) I have an injury that stops me from exercising.

12) I have a health problem & I do not know if exercising will help it or make it worse.

16) I do not have a place to exercise where I feel safe.

17) I feel embarrassed when I exercise around other people.

18) I do not like being around other people when I exercise.


Motivators for & Barriers to Health-Smart

Behavior InventoryHealthy Breakfast--MotivatorsDesire to be Healthy

AvailabilityFamily Influences

Healthy Breakfast—Barriers

Healthy Foods & Snacks—Motivators

Healthy Drinks--Motivators


Convenience

Time

Healthy Foods & Snacks—Barriers

Cultural Familial Influences

Availability

Medical IssuesHealth Benefits

Routine

Negative AttitudesAvailabilitySelf-Control

PreferenceMedical Health

IssuesAwarenessHealthy Drinks--

BarriersSocial InfluencesKnowledgeAvailabilit

yPhysical Activity--Motivators

Physical Activity--Barriers

General CommitmentPriorities

Goals/BenefitsPersonal

PreferenceMedical Health Issues

Self-Consciousness

Environmental SupportMedical Health

Issues

Preferred Alternatives

Questions &

Answers

Stretch Break


Motivators for & Barriers to Health-Smart

Behavior InventoryHealthy Breakfast--MotivatorsDesire to be Healthy

AvailabilityFamily Influences

Healthy Breakfast—Barriers

Healthy Foods & Snacks—Motivators

Healthy Drinks--Motivators


Convenience

Time

Healthy Foods & Snacks—Barriers

Cultural Familial Influences

Availability

Medical IssuesHealth Benefits

Routine

Negative AttitudesAvailabilitySelf-Control

PreferenceMedical Health

IssuesAwarenessHealthy Drinks--

BarriersSocial InfluencesKnowledgeAvailabilit

yPhysical Activity--Motivators

Physical Activity--Barriers

General CommitmentPriorities

Goals/BenefitsPersonal

PreferenceMedical Health Issues

Self-Consciousness

Environmental SupportMedical Health

Issues

Preferred Alternatives

Change negative,

hopeless, or unproductive

health thoughts

INTERPRETIVE PHENOMENOLOGICAL

ANALYSIS…human beings…come to

interpret & understand their world by formulating their own biographical stories

into a form that makes sense to them.Brocki, J. M. & Wearden, A. J. (2006). A critical

evaluation of the use of interpretive phenomenological analysis (IPA) in health psychology. Psychology & Health, 21(1), 87-108.

Werner-Lin, A. & Gardner, D. S. (2008). Family illness narratives of inherited cancer risk: Continuity & transformation. Family Systems, & Health,27(3), 201-212. doi:10.1037/a00169883

…[t]he dominant themes of any narrative are largely determined by the temporal &

relationship context within which stories are created &

shared…(p.204)


…Greater freedom of narrative construction may allow [us] to

identify novel pathways

to sustained physical & mental health by focusing

decision making in the future rather than the

past…(p.209)

Most humans fully expect to die1

“Self-fulfilling prophecy”

‘reality’of human‘aging’‘reality is an illusion; albeit a very persistent one’ —Albert Einstein

1Kotter-Grühn, D., Kleinspehn-Ammerlahn, A., Gerstorf, D., & Smith, J. (2009). Self-perceptions of aging predict mortality & change with approaching death: 16-year longitudinal results from the Berlin aging study. Psychology & Aging, 24(3), 654-667.

“…when people experience losses in physical health or cognitive

fitness, they attribute the change to the aging

process…”1 (p. 655)

“…gradual loss of muscle strength is the

main reason [the] elderly…have

difficulty performing tasks of daily living

& ultimately lose their independence…”1

p. vii

“Normal aging” or simply disuse?

1Peterson, T. (2008). SrFit: The personal trainer’s resource for senior fitness. American Academy of Health & Fitness.

How does holding this

belief affect what you

personally eat & how much you

personally exercise?

Do you believe that all people will die?


…charting the evolution of stories over time

allows [one] to track the integration of

transformative narratives

& to identify potential targets for intervention…

(p. 201)


Case scenario one: “Well, no, I do not eat healthy. I have to say that fruits & vegetables don’t at all taste good to me. Besides, I figure that you only live once: what is the point of depriving yourself of tasty foods if you are just going to die like everyone else anyhow. No, my physician has not really mentioned that diet & exercise could help me to manage my high blood pressure or my diabetes; but even if he did, I am not sure that I would follow his advice: after all, he is pretty overweight & I probably also has high blood pressure, too. I really do not make any sense of all the information out there today about a healthy diet: people ate healthy years ago & they died; it does not make sense to me that eating healthy or exercising helps me—it just seems like a lot of hard work & a lot of doing without.”


Case scenario two: “Well, yes, I eat healthy. I have to say that fruits & vegetables taste good to me now—sweet, salty, & high fat foods do not even seem like food. Besides, I figure that you only live once: what is the point of eating rich & unhealthy foods that hurt your body & cause disease? Yes, my physician mentioned that diet & exercise could help me manage my diabetes & high blood pressure: that is why I changed my habits—I did not eat very well before & hardly got off the couch after work. Now I take a 30-minute walk most nights. It probably helped that my doctor is lithe & athletic: no extra weight & I bet that she eats well & exercises. I can make a lot more sense of the information about a healthy diet now: a defeatist attitude about death is not going to stop me from taking care of my body.”

Societally common‘cognitive script’ regards one’s body &

‘aging’• I am old.

• My body is flabby & wrinkled—it hurts a lot many/most days. Many parts do not

work well (if at all). • Everyone’s body will just get old like

mine—why even bother to eat well, exercise, or take care of myself now?

• Nothing can be done—& I will eventually die; everyone knows that.

Cognitive Distortions1

All or nothing thinking: It sees aging & health in absolute, black & white terms.Mental filter: It dwells on the negatives & ignores the positives.Overgeneralization: It views the state of a person’s body as a never-ending pattern of defeat.Jumping to conclusions: Decides in advance the outcome of an aging body.

1Burns, D. (1980). Adapted from Feeling Good: The New Mood Therapy (New York: William Morrow & Company;, 1980; Signet, 1981). Retrieved on 23 May 2014 from http://www.apsu.edu/sites/apsu.edu/files/counseling/COGNITIVE_0.pdf

Sample new ‘cognitive script’• It is too bad that I have not cared for

myself as well as I could have. After so many years my body sure does need a

tune-up! • Most people think that a body so old as

mine can't be restored—& I certainly cannot undo the past.

• Still, new medical & psychological research shows that a healthy diet & exercise can

restore many aspects of how my body works.

• I can change my body for the better—& eating well & exercising daily will help me

do that.

Dare we imagine an alternate

future story line…global health for

all…?


Who knows—maybe death just means that our bodies wear out because we don’t take care of them—or the rest of us: our minds, our emotions, our

spirits. It makes sense to me that eating healthy or

exercising helps me—though it was a lot of hard work & a lot of doing without—but now I see that it definitely pays off with extra energy & umph for

life.

The Ultimate‘Cognitive Script’

Goal for healthy living

one small action at a time

…health becomes the norm…and death is no more.

Employ psychological tools to make

positive health choices


Have you tried out these apps for fitness & health??

Apps for Fitness & Health

Health Self-Empowerment Theory


“…engagement in health promotingbehaviors & avoidance of health-risk behaviors are influenced by the following five empirically based, modifiable, self-empowerment-oriented

variables: (a)health motivation (b)health self-efficacy (c)self-praise of health-

promoting behaviors(d)health responsibility &

(e)active coping strategies/skills for

managing stress & depression

Health Self-Empowerment Theory


Of these…

may be the most important…”health motivation

“…engagement in health promotingbehaviors & avoidance of health-risk behaviors are influenced by the following five empirically based, modifiable, self-empowerment-oriented

variables:

Self-regulation of Health Behavior

Mann, T., de Ridder, D., & Fujita, K. (2013). Self-regulation of health behavior: Social psychological approaches to goal setting & goal striving. Health Psychology, 32(5), 487-498.

For example, they may agree that

health is important

without committing themselves to eating more vegetables & fruits or

exercising regularly.” (p. 488)

“People may value good health without actually adopting a health goal that

guides their behavior:



• Goal-setting —determining which goals one wants to pursue & the criteria for judging success

• Goal striving —planning & executing actions that promote goal attainment & shielding those goals from distraction or disruption.

“Self-regulation is an umbrella term used to describe the various processes by which people

pursue & attain goals.”



“Although people may desire or intend to attain some outcome, they are not committed to that as a

goal until they are willing to invest

affect, cognition, &

behavior in attaining it.” Goal intentionsspecify a desired end state

Goal commitmentindicates how much that end state is desired & motivates

action.



“…health goals compete with goals in other important life domains for

the scarce resources of time, energy, & money...”

[P]eople are unlikely to adopt a health goal if it would interfere with a goal that is more important to

them.


• Set an “approach” goal

—you want to achieve a certain outcome

• Set a “mastery” goal

—you want to perform a certain skill better• Look at

both“feasibility” & “desirability”

— “unrealistic” goals may inspire (rather than undermine) goal

pursuit

Goal-Setting Tips


•“Look ahead” to identify potential

obstacles—plan ways to stay focused on your

goal• Cue a “habit” for

your goal—set up a reminder for the action you

want• Help yourself to

“prefer” the health goal’s outcome

Goal-Setting Tips


To “inhibit” behaviors that undermine your health goals

• Takes mental resources

• Takes motivational resources

May even “backfire” due to resource depletion

Goal-Setting Tips


• Have a positive mood• Remind yourself of your core values

• Challenge your expectations of failure

•Make plans to do the healthy action

•Reduce belief that your willpower is limited

How to restore motivation:

Perceived control

Friedman & Kern (2014). Personality, well-being & health. Annual Review of Psychology, 65, 710-742. Seligman, M. E. P. (2008). Positive Health. Applied Psychology: An International Review, 57, 3-18. doi:10.1111/j.1464-0597.2008.00351.x

Individuals who are conscientious

—that is,prudent, dependable, well organized, & persistent—stay healthier,

thrive, & live longer… the size of this effect is equal to or

greater than that of many known biomedical risk factors.”

(p. 731; emphases mine)

What will you do to live more healthy? Make a plan today!

S.M.A.R.T goals

Set a goal to increase one of the 4 healthy behaviors:

Exercise

Water &

other low-sugar


Healthy Breakfast


1)List 3 motivators for the behavior

2)List 3 barriers to the behavior

3)Decide when you will do it 4)Plan how you will succeed5)Set a time to check back

on your progress

What will you do to live more healthy? Make a plan today!Set a goal to increase one of the 4

healthy behaviors:

Exercise

Water &

other low-sugar


Healthy Breakfast


S—specificM—measurableA—attainable R—realistic T—timely

What will you do to live more healthy?

Exercise

Water &

other low-sugar


Healthy Breakfast


Burke, M. (2014, January). Motivational interviewing. Mayo Clinic Wellness Coach Training, Rochester, MN.

•Why would you want to make this change?•How might you go about it in order to

succeed?•What are the 3 best reasons to

do it?•What gets in the way of those 3 best

reasons? •So, what do you think you’ll do?

Make a plan

today!

…a tutorial to help physicians …Physician Heal Thyself?


1. Understand motivators for & barriers to healthy behavior

2. Change negative, hopeless, or unproductive health

thoughts 3. Employ psychological tools

to make positive health choicesConcrete take-home tasks

Exercise

Water & other low-sugar drinks

Fruits, vegetables, & whole grains

Healthy Breakfast



Closing thoughts…

Exercise

Water &

other low-sugar


Healthy Breakfast


•Exercise at least 150

minutes + two strength building

sessions per week

•Eat a plant- based diet high in whole

grains, vegetables, &

fruits

ReferencesAmerican Medical Association (2004). Ethics Opinion 9.0305—Physician Health & Wellness. Based on the report “Physician Health & Wellness” adopted December 2003. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion90305.pageBrocki, J. M. & Wearden, A. J. (2006). A critical evaluation of the use of interpretive phenomenological analysis (IPA) in health psychology. Psychology & Health, 21(1), 87-108.Erskine, J., Lanigan, A., Emsermann, C. B., Manning, B. K., Staton, E. W., & Pace. W. D. (2012). Use of the Americans in Motion-Healthy Intervention (AIM-HI) to create a culture of fitness in family practice. J Am Fam Med, 25, 694-700. Fentem, P. H. (1994). Benefits of exercise in health & disease. British Journal of Medicine, 308, 1291-1295. Friedman & Kern (2014). Personality, well-being & health. Annual Review of Psychology, 65, 710-742. Kotter-Grühn, D. et al. (2009). Self-perceptions of aging predict mortality & change with approaching death: 16-year longitudinal results from the Berlin aging study. Psychology & Aging, 24(3), 654-667.Reilly, M. J. (2007). Are obese physicians effective at providing healthy lifestyle counseling? Am Fam Physician, 75(5):738-741. Retrieved on 17 May 2014 from http://www.aafp.org/afp/2007/0301/p738.html. Seligman, M. E. P. (2008). Positive Health. Applied Psychology: An International Review, 57, 3-18. doi:10.1111/j.1464-0597.2008.00351.x Tucker, C. M.,…Desmond, F. F. (2011). Development of the Motivators of & Barriers to Health-Smart Behaviors Inventory. Psychological Assessment, 23(2), 487-503. doi:10.1037/a0022299Tuso, P. J., Ismail, M. H., Ha, B. P., & Bartolotto, C. (2013). Nutritional update for physicians: Plant-based diets. The Permanente Journal, 17(2), 61-65. Retrieved on 23 May 2014 from http://dx.doi.org/10.7812/TPP/12-085Werner-Lin, A. & Gardner, D. S. (2008). Family illness narratives of inherited cancer risk: Continuity & transformation. Family Systems, & Health,27(3), 201-212. doi:10.1037/a00169883Westcott, W. L. & La Rosa Loud, R. (2013). Enhancing resistance training results with protein/carbohydrate supplementation. American College of Sports Medicine’s Health & Fitness Journal, 17(2), 10-15.



http://www.aafp.org/afp/2007/0301/p738.html

http://dx.doi.org/10.7812/TPP/12-085

Supplementary ReferencesAmerican Diabetes Association. (2014). Food & Fitness. Retrieved on 20 April 2014 fromhttp://www.diabetes.org/food-and-fitness/American Heart Association. (2014). Getting Healthy. Retrieved on 20 April 2014 from http://www.heart.org/HEARTORG/GettingHealthy/GettingHealthy_UCM_001078_SubHomePage.jspEstruch, R. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med, 368, 1279-1290.

Goldenberg, J. L. & Arndt, J. (2008). The implications of death for health: A Terror Management Health Model for behavioral health promotion. Psychological Review, 115(4), 1032-1053.Greenberg, J., Martens, A., Jonas, E., Eisenstadt, D., Pyszczynski, T., & Solomon, S. (2003). Psychological defense in anticipation of anxiety: Eliminating the potential for anxiety eliminates the effect of mortality salience on worldview defense. Psychological Science, 14(5), 516-519. Infurna F. J. & Gerstorf, D. (2013). Linking perceived control, physical activity, & biological health to memory change. Psychology & Aging, 28(4), 1147-1163. Infurna F. J. & Gerstorf, D. (2014). Perceived control relates to better functional health and lower metabolic risk: The mediating role of physical activity. Health Psychology, 33(1), 85-94. Wong, T. P. (2011). Positive Psychology 2.0: Towards a balanced, interactive model of the good life. Canadian Psychology, 52(2), 69-81. Wurm, S., et al. (2013). How do negative self-perceptions of aging become a self-fulfilling prophecy? Psychology & Aging, 28(4), 1088-1097.

http://www.diabetes.org/food-and-fitness/

http://www.diabetes.org/food-and-fitness/

http://www.heart.org/HEARTORG/GettingHealthy/GettingHealthy_UCM_001078_SubHomePage.jsp

http://www.heart.org/HEARTORG/GettingHealthy/GettingHealthy_UCM_001078_SubHomePage.jsp


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