Steven R. Hawks

Review of Spiritual Health: Definition, Role, and Intervention Strategies in Health Promotion

Purpose of the Review. Recognition of the spiritual dimension as a vital component of human wellness has led to an increased interest in spirituality education, yet very little progress has been made in identifying possible intervention methods for enhancing spirituality. The purpose of this article is to review current definitions of spiritual health; provide an overview of several successful intervention methods that may enhance spiritual health; and outline potential relationships between spiritual health interventions and behavioral, emotional, and physical health outcomes. Search Method Used. Research and review articles were identified through a CD-ROM computer search of ERIC (1966 to 1994), PSYCHLIT (1974 to 1994), and MEDLINE (1991 to 1994) databases using appropriate key words. Cumulative indexes from Advances (1984 to 1993) were manually searched, and reference lists from identified studies and literature reviews were analyzed. A total of 71 articles were identified and considered. Model interventions were chosen for presentation on the basis of soundness of research design, peer-review publication, clear description of intervention method, and relationship to spiritual health components. Summary of Important Findings. Imagery, meditation, and group support activities may address various components of spiritual health such as meaning and purpose in life; self-awareness; and connectedness with self others, and a larger reality. In turn, positive changes in health behaviors such as communication, diet activity, and treatment compliance were noted, and a variety of beneficial physical and emotional health outcomes such as heart disease, reversal, decreased cancer mortality, reduced anxiety, and improved mood states were reported. Major Conclusions. Health educators are in a position to develop, implement, and evaluate spiritual health interventions within the context of comprehensive programs. There is a need for training in the theoretical and methodologic foundations of interventions like meditation, imagery, and group support and a need for more evaluation research in the impact of such interventions.

The Relationship Between Intuitive Eating and Health Indicators Among College Women

Abstract Epidemic levels of obesity represent a growing public health problem associated with a variety of negative health outcomes. Population level interventions that aim to moderate obesigenic environments have been proposed but remain largely unimplemented. Standard individual level interventions that focus on dietary restraint have been ineffective and in some cases harmful. Intuitive eating, an anti-dieting strategy that relies on recognizing and responding to internal hunger and satiation cues, has been proposed as an alternative approach to healthy weight management at the individual level—but it remains largely untested. This study evaluated the relationship between intuitive eating and various health indicators among female college students. As measured by the Intuitive Eating Scale (IES), it was found that intuitive eating was significantly correlated with lower body mass index (r = -.576), lower triglyceride levels (r = -.408), higher levels of high density lipoproteins (.437), and improved cardiovascular risk (r = .425). Findings provide tentative support for intuitive eating as a positive approach to healthy weight management at the individual level. Implications and future research needs are discussed.

Spiritual Wellness, Holistic Health, and the Practice of Health Education

Abstract The current practice of health education often fails to harmonize with the multidimensional, dynamic, and functional nature of health as generally defined within our profession. As a stepchild of the medical and public health professions, we have inherited a preoccupation with physical health as the most worthy outcome measure for most of our programs. Yet other dimensions of health seem equally important and even essential to the overall well-being of program participants. There exists an opportunity for health educators to move toward models of health promotion that more fully appreciate the interconnectedness of various dimensions of health and that promote them evenhandedly. This article argues that spiritual health is an underlying dimension that contributes to social and emotional health, which in turn provide motivation for health behavior changes that determine physical and intellectual health. To the degree attained, physical and intellectual health become tools for realizing the purpose and meaning in life that the spiritual worldview portrays. Practical application of this model requires a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships, and new educational approaches that are capable of promoting positive outcomes in a variety of health dimensions.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image. DESIGN A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight. SETTING In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics. SUBJECTS The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments. RESULTS Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours. CONCLUSIONS There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

The Intuitive Eating Scale: Development and Preliminary Validation.

Abstract This article describes the development and validation of an instrument designed to measure the concept of intuitive eating. To ensure face and content validity for items used in the Likert-type Intuitive Eating Scale (IES), content domain was clearly specified and a panel of experts assessed the validity of each item. Based on responses from 391 university students in the United States, the IES was evaluated for internal consistency and reliability using cross-tabulations, factor analysis, test–retest correlation coefficients, and logistic regression techniques. The factor solution isolated four factors that replicated scale construction, including intrinsic eating, extrinsic eating, antidieting, and self-care with alpha coefficients ranging from .42 to .93. Retesting after 4 weeks (N = 285) yielded correlation coefficients that ranged between .56 and .87. The presence of theorized relationships between IES scores and certain demographic and lifestyle variables (obesity, presence of an eating disorder, gender, and restrictive dieting) adds support for concurrent validity. IES subscales also correlated significantly with the Cognitive Behavioral Dieting Scale in predicted directions, suggesting convergent validity. Findings provide tentative support for the use of the IES in identifying intuitive eating attitudes and behaviors among college populations. Implications for practice, theory, and future research are discussed.

Weight Loss Education: The Challenge of a New Paradigm

Health educators and others typically rely on three weight loss strategies to combat obesity. These include (1) medical intervention, (2) caloric restriction, and (3) fat gram restriction. The empirical evidence for these approaches in producing long-term weight loss is weak. However, much media attention has been given to a weight loss paradigm that seemingly does not fall into the aforementioned categories, which has been called the intuitive eating paradigm. Currently there is no empirical evidence to validate this paradigm. The focus of this article is to present an overview of this weight loss paradigm, discuss its potential benefits for health education in relation to current weight loss paradigms, and critically evaluate it in terms of the usefulness and ethical appropriateness for health education.

Classroom Approach for Managing Dietary Restraint, Negative Eating Styles, and Body Image Concerns among College Women.

Objective: In this exploratory study, the authors evaluated the impact of an elective college course on dieting levels, eating styles, and body image among college women. Participants: Participants were a convenience sample of 29 self-selected female students at a western university who were mostly white, normal-weight seniors with significant dieting experience. Methods: The authors used valid and reliable instruments to collect data both before and after testing. An instructor conducted the program in an undergraduate course that met twice weekly for 15 weeks. Theory-based lessons focused on resisting media pressure, modifying dietary restraint, eating in response to hunger (intrinsic eating), and achieving healthy body image. Dependent variables included intrinsic eating, dieting involvement, emotional eating, body image, and self-esteem. Results: A comparison of pretest and posttest scores identified significant improvements for most measures. Conclusions: A theory-driven elective course implemented within a college setting may improve womens eating styles and body image.

VALIDATION OF THE MOTIVATION FOR EATING SCALE

For items used in the Likert-type Motivation for Eating Scale (MFES), content domain was clearly specified and a panel of experts assessed the relevance of each item. Based on responses from 298 participants in the western United States, the MFES was evaluated for internal consistency and reliability using factor analysis and correlation techniques. The factor solution isolated four factors that replicated scale construction, including: environmental eating, emotional eating, physical eating, and social eating with alpha coefficients ranging from .75 to .95. Retesting after two weeks (N=88) yielded correlation coefficients that ranged between .55 and .77. Theorized relationships between subscale scores and certain demographic variables add support for concurrent validity. MFES subscales also correlated predictably with select subscales from the Emotional Eating Scale and the Three Factor Eating Questionnaire suggesting convergent validity (N=103). Findings provide tentative support for use of the MFES in community and college settings.

Obesity and Body Size Preferences of Jordanian Women

The nutrition transition is associated with increased obesity rates and increased desire to be thin. This study evaluates the relationship between actual body size and desired body size among a representative sample of 800 Jordanian women. Using Stunkard’s body silhouettes, women were asked to identify their current and ideal body sizes, healthy body size, and their perception of the body size preferred by men. Body mass index (BMI) calculations indicate that 53.8% of the women were overweight or obese. Their mean current body size was 5, which is consistent with the mean BMI of 26 in the sample. Although 66% of the women were dissatisfied with their body size, the desired weight loss was not extreme. Pearson correlation was positive (.858, p <.0001) between measured BMI and body silhouettes chosen as an indicator of current body size. Jordanian women seemed pulled between the traditional and Westernized body preferences. Possible cultural explanations are explored.

Weight Loss Management: A Path Lit Darkly

This article reviews recent research on the prevalence and virulence of obesity as a causal risk factor for mortality and morbidity. The prevailing assumption that obesity, by itself, is a chronic disease or a primary risk factor for health is challenged. A historical perspective is used to analyze the efficacy of various medical and educational approaches that have attempted to alter body size in the pursuit of enhanced physical health. The motivational discrepancies between societys media-induced desire for thinness and the health fields risk reduction approach to weight loss are outlined. Finally, ethical issues are raised in relation to current weight control measures, implications for future educational efforts are discussed, and potential guidelines for future weight management programs are presented.