Issues of Health and Society: Weighing In (Obesity)

Jacob P. Harney, Ph.D. Co-developer of curriculum, coinstructor (attended SSI 2004, 2005).
Jacob P. Harney’s Profile Page
Marissa Cloutier, MS, RD. Co-developer of the curriculum and co-instructor (attended SSI 2005).

Additional University of Hartford Faculty Contributors:
Mala Matacin, Ph.D (attended SSI 2005)
Betsey Smith, Ph.D. (attended SSI 2005)
Catherine Certo, Ph.D.

Abstract

A 1999 study determined that 65% of US adults were overweight or obese and that childhood obesity has tripled in the last two decades. Apart from the impact on public health, the economic cost of this problem is enormous, with $117 billion lost through increased medical costs, diminished employee productivity, absenteeism, and loss of income.

Issues of Health and Society: Weighing In is a laboratory course that meets the general education science requirement for all non-majors. It teaches “through” obesity to the basic biochemistry of food (calories, carbohydrates, fats, proteins, macro, and micronutrients) and the biology of energy metabolism (intake, storage, endocrinology, digestion, metabolic expenditure). Physiology (exercise, body mass, anthropometrics), and mathematics (percentages, conversion rates, statistics) are also covered, as are psychology (body image, behavior, eating disorders), sociology (stigma, consumer choices and marketing), and political science (government policies and food industry practices), so that students connect the science to cultural, economic and, social cultural factors that lead to obesity and overweight.

In addition to laboratory and writing assignments, students engage in a semester-long “Make a Difference” project, which is a collaboration between the University of Hartford (UH) and its magnet school. UH students collect detailed health data, including body mass index, blood pressure, and heart rate from the magnet school students, who then keep detailed diaries on all food intake and all physical activity for 4 days. UH students analyze their findings and present them to the children and their families at the end of the semester, along with recommendations about nutrition, exercise, and other behavioral modifications that will combat obesity and lower the risk of type II diabetes.

Course Goals

This course will evaluate the physiological, psychological and social causes and consequences of obesity in children and adults. At the end of this course students will be able to:

  1. Predict the impact of specific changes in micro and macro-nutrient intake on BMI–basic digestion, absorption, cellular respiration, anabolism
  2. Calculate and analyze nutrient composition of foods.
  3. Formulate diets and exercise programs that will result in net energy expenditure and net energy storage.
  4. Analyze how obesity impacts ones ability to function in daily activities, i.e., work, leisure and activities of daily living
  5. Interpret the difference between being fit and being fat.
  6. Critically analyze the different modes of treatment: diet, drugs, surgery and behavioral therapy.
  7. Evaluate the influence of nutrition and weight management in health promotion and disease prevention (such as diabetes and heart disease)
  8. Analyze the cost of obesity-related disease treatment to the cost of healthcare.
  9. Analyze the obesity industry (diets, exercise programs, drugs) with regard to local, national and international economies.
  10. Critique the social and psychological consequences of obesity myths.
  11. Critique their own reactions to obese people based on sexism and socially constructed ideas.

The Course

Syllabus

Syllabus for Issues of Health and Society: Weighing In (Obesity)

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Course Description

This integrative course in the sciences is a multidisciplinary exploration of one the more pressing current issues of health and society, obesity. It reviews basic energy consumption, utilization and storage as will as the biological, historical, social,psychological and health issues related to obesity and its treatment. The economic impact of obesity on health care, employment, travel, and the diet and food industries will also be examined. Students will gain an overall perspective on the impact that body mass has on society.

Lecture

Class participation is central to the success of this course. Attendance will be taken and is mandatory to pass this course. Short answer and essay questions will be assigned weekly but answers will only be accepted from students who have attended class. Therefore missing class means missing assignments.

Linking Science and Social Issues

Why is This Course an Emerging SENCER Model?

The SENCER ideals focus on connecting science with civic engagement by teaching “through” complex, contested, capacious, current and unresolved public issues “to” basic science. Presently there is arguably no greater complex, capacious and current unresolved public issue than obesity. At its heart obesity focuses on energy imbalance in the human organism. The basic science related to energy metabolism, while generally well understood in the broader sense, continues to be the focus of scientific research around the world. Understanding metabolic pathways and the sources of, use for, and storage of energy, however, is simply scratching the surface of the problem of obesity. “Energy in” is defined simply as what and how much we eat, it must be understood in the context of when we eat, and most importantly, why we eat. “Energy out” is what we use to maintain vital functions like breathing, blood circulation and movement. A severe or long-term imbalance between energy in and energy out creates an obesity problem and that problem is inextricably tied a myriad of physiological, sociological, psychological, cultural, and economic factors that impact the whole of society and not simply the individual.

The topic of obesity represents an opportunity to explore science from a multidisciplinary standpoint and both the advantages and the limitations of purely scientific approaches in addressing this problem are evident when on considers the physiological and psychological causes and consequences of obesity. The contested issues that surround how we choose to live our lives and what our appearance says about our societal worth are questions of deep interest to students and foster student engagement within the classroom and in the broader community.

Obesity is not simply an American problem, it represents a global epidemic. The prevalence of overweight and obesity is increasing worldwide at an alarming rate in both underdeveloped and developed countries. Modernization, urbanization, and economic development have resulted in environmental and behavioral changes that are linked to the rise in global obesity in adults and children. Present statistics indicate that approximately 15 % of adolescents (12 to 19) and children (6 to 11) are obese. Compare those percentages to 1976-1980 (5% and 7%, respectively) and it is quite clear that we are in the midst of an epidemic that has the potential for far-reaching and devastating consequences for humankind…

What are the Civic Questions Addressed in the Course?

The civic engagement questions addressed in this course dealt how to handle the public health crisis that our nation, and now increasingly many others in the world, are facing. Obesity was the central theme for our course, but cardiovascular disease, diabetes, and depression, which are directly linked to obesity, were also addressed. In essence, the importance of individual health for societal well-being, and ultimately, global health, was emphasized, but it also foregrounds the question of the dividing line between individual and societal responsibility. That is, each individual is in control of the choices they make that affect their health, but when the individual is placed in a “toxic” environment that actually inhibits individual choice and control over eating, what society action is theoretically possible to reverse the public health trends that we are facing? What should be the government’s role in regulating that environment?

No matter what one’s position is on government regulation, however, we are all concerned with the well being of our children. We have found that childhood obesity is a useful topic for ideological differences and finding common ground. Students displayed an insightful awareness of the complexities of the issues surrounding childhood obesity – an understanding that aided by the examination of the ethical requirements of governmental food industry regulation, as well as address how and why it is that an system of food production, sale, and consumption that promotes obesity and other health “imbalances” is allowed to grow.

What is STEM Content Covered and How is it Linked to the Civic Content?

The science required to understand obesity includes biochemistry of food (calories, carbohydrates, fats, proteins, cholesterol, macro, and micro-nutrients); the biology of energy metabolism (intake, storage, endocrinology, digestion, metabolic expenditure); physiology (exercise, body mass, anthropometrics); mathematics (percentages, conversion rates, statistics).

Civic and social issues raised by obesity include body image, behavior, eating disorders, and the economic cost of obesity in terms of public health risks (diabetes, hypertension); the sociology of obesity and overweight (stigma, consumer choices, marketing, employability), policy questions (government policies, food industry practices.

This course is team taught by experts in biology, nutrition, psychology, occupational therapy and physical therapy and the integration of the science and civic content occurs throughout the lectures and laboratory assignments. The semester-long research project (Make a Difference) allows students to collect scientific data on the individual children and analyze that data in the context of their eating and activity patterns, as well as the cultural and environmental factors that affect the children’s eating decisions.

The potential to teach science content through the issue of obesity is great. Possibilities include:

Natural and Physical Science – General biology, anatomy & physiology, biochemistry, chemistry, and physics (thermodynamics) can be successfully unified in this course. Principles of environmental science can also be incorporated. In essence, this is a “nutrition science” course – which is unique field of study that incorporates all of the above, along with sociology, psychology, and education theory. Along with nutrition science, exercise physiology is an area that should be specifically addressed in this course as well. Clearly, this course can be taught as rigorously as desired. Students need a strong understanding of the basic principles of the above sciences to fully grasp the civic issues at hand: the impact of the environment (and the chemicals within) on individual wellness, and the impact of individual well being on global health.

Technology– Technology can be examined with respect as to whether it is exasperating the obesity problem or helping to mitigate it. Technology can make us more sedentary, but it can also allow us to telecommute, enabling us to avoid long drives to work, and ultimately free up time for physical activity. Technological discussion can also be incorporated into this course within the realm of public health mass communications. That is, how best can the wellness message efficiently and effectively be delivered to the masses? How can we engage and educate children about the issues of health and well being? How can we use available and economical technology to engage the public? Web site development, interactive computer software design, nutrition database development, etc. could effectively be incorporated in this course.

Engineering – Engineering principles could be discussed throughout this course, from the overall impact of obesity on the design of new automobiles, furniture, medical examination tables, etc, to the effects of heavy and imbalanced tissue masses on the human skeleton can be explored. Also, the need of raising the importance of designing communities that promotes physical activity as much as possible should be discussed. To fully address the health crisis at hand and the importance of a healthy society for prosperity, one would definitely need to address the needed infrastructures to support wellness. Therefore, civil engineering, etc. instruction would be pertinent in such a course.

Math – Mathematics is essential in any science course, and this is especially true here in a course that aims to fully demonstrate the civic health
issue at hand. Students were required to economically “crunch” numbers, use percentages, and calculate rates. They utilized formulates to calculate Resting Metabolic Expenditure, Body Mass Index, Daily Caloric Requirement, Recommended Daily (Nutrient) Values, and caloric/nutrient content of selected foods. Basic statistical principles can also be explored as thoroughly as desired.

Evaluating Learning

Assignments

Students were assigned questions as homework prior to class discussion of the topics to help ensure reading of assigned materials in a timely fashion. In addition students were assigned several short papers during the semester on select topics. A sample assignment is included below:

Energy Metabolism – Chapter 6

Homework Questions

  1. What are the three principal components of energy expenditure and what are their percentage contributions to total daily energy output?
  2. What is the difference between anaerobic and aerobic metabolism?
  3. What does “Fats burn in a carbohydrate flame” mean?
  4. What is a respiratory quotient (RQ) and what do they tell us?
  5. What is the caloric value of oxygen and why does it vary?
  6. What is metabolic rate and what factors impact it?
  7. What is DIT and why is the data in humans unclear?
  8. Based on what you have read about energy metabolism why is it better to avoid obesity in the first place than to try and reverse it?
  9. What appears to be the most effective way to ensure oxidation of fat and why?
  10. Using the Case Study on pg 225 estimate your RMR. What was the highest and lowest estimate and are there any factors not reflected in these formulas that might influence your metabolic rate?

Course Management and Strategies

The course was taught in a team-oriented format. There were 2 co-instructors who covered the majority of the biological, nutritional, and health-related curriculum. In addition, there were other faculty members who contributed to both lecture and lab in their areas of expertise: a psychologist, occupational therapist (who is well versed in the sociological issues surrounding obesity), and a physical therapist (who offered her insight into the vital role of exercise in weight control and disease prevention). Although the University of Hartford’s exercise physiologist was unable to guest lecture last semester, she consulted us on lab course content. Outside speakers were also used to cover topics including bariatric surgery and obesity in the clinical treatment setting.

All materials and assignments were managed through a Blackboard website specifically designed for the course. Numerous strategies were used to engage the educational experience including group discussions.

Grading Policy

Class/homework assignments: 35%
Laboratory: 35%
Make-a-Difference Project: 30%

Evaluation and Assessment

Standardized University of Hartford AUC student evaluations were given at the end of the semester and a final brief questionnaire was also given on the last day of the semester. The quantitative and qualitative evaluations for this course were outstanding. The students almost unanimously indicated that the course had really impacted their life and had changed how they viewed science, nutrition and the obesity issue.

Laboratory

Laboratory responsibilities, expectations and grading of each lab will be discussed at each laboratory. There are no make-up labs. Attendance at laboratory is mandatory to pass this course. Missing 3 labs or more will result in a non-passing grade.

Make-a-Difference Project

The Make-a-Difference project will constitute a semester long project where each student will each adopt a “subject” from the University of Hartford Magnet School. The class will collect and analyze the data (including BMI, age, gender, race) from all 3rd-5th grade students at the Magnet School. All students in those grades will be asked to complete food and activity surveys over a 4 day period. The most complete surveys will be used as “subjects”. Each student will then work with the data from their subject to examine diet, physical activity, caloric input and output and then make assessments and general recommendations based on “best practices”. In collaboration with the school nurse, physical education teacher and visiting doctor student reports will be “screened” and then shared with the families to help make-a-difference in the families’ lives. This project will be discussed and implemented in the first few weeks of class and will culminate in project presentations to all students and interested families at the Magnet School at the end of the semester.

Semester Long Research Project

Make a-Difference Project

This project constitutes 45 % of your final grade and is broken up into three parts.

Part 1 – General Term Paper

In this portion of the project you will write a term paper (~20 pages double-spaced plus references) that will bring together all that you have been exposed to and have learned in this course. This paper is your opportunity to present the obesity issue in total including discussing the following topics:

  1. Introduction to the problem- statistics, prevalence, etiology, nationally and in CT.
  2. Diseases associated with obesity (diabetes, cardiovascular, hypertension, dyslipidemia, etc.) and the problems they represent in health and cost.
  3. Nutrition- good versus bad (“whole” vs. processed carbohydrates, fats – plant based vs animal based vs. trans fats, vitamins/minerals, water, phytochemicals, sugar substitutes, antioxidants, etc.-how do the food chemicals you consume, natural or artificial, affect biology, wellness, and the risk of developing obesity and other chronic problems. How do the chemicals that you consume, smell, or see, affect one’s natural ability to regulate intake)
  4. Metabolism- how energy is stored, energy intake vs. expenditure, BMR, thermogenesis, physical activity- what you can change and what you can’t change.
  5. Eating behavior, hunger, satiety…endocrinology and psychology…is our behavior hereditary or not.
  6. Treatments: The physiological and psychological impacts of: Changing Diet, Changing Physical activity, Non-behavioral approaches
  7. Why treatments work differently for different people.
  8. What are the societal issues that are impacted by and influence obesity.
  9. Take home lesson—-the complexity of the problem.

Part 2 – Magnet School Subject

In this portion of the project you will conduct analyses of the food and physical activity logs from the Magnet School subjects. Using your general term paper as reference you will evaluate the status of your subject and then make observations and “general wellness recommendations” on nutrition and physical activity based on “best practices” that you have learned in class.

Part 3 – Posters for Health/Wellness Fair

In this portion of the project you will be broken up into groups of 4-5 and you will be assigned a topic to present in a poster format at the presentation to the Magnet School. As this project is geared towards 3rd-5th graders and their parents we will be looking for creative ways to make this event both fun and informative (puzzles, games, etc.).

Make-a-Difference Project:

In March 2004, the Center for Disease Control announced that the second leading cause of death in 2000 was poor diet and physical inactivity. We now recognize that obesity is a public health crisis in Connecticut and the nation. In 2005, the Connecticut Department of Public Health, recognizing the crisis, published Connecticut’s Plan for Health Promotion entitled “Healthy Eating and Active Living”. This plan has 3 major goals: “to develop a comprehensive state infrastructure for obesity prevention and control, develop, implement and evaluate a community-level model for obesity prevention and control and create a mechanism for promoting and tracking environmental and policy changes and outcomes related to promotion of increased physical activity and improved nutrition practices.” Connecticut’s plan is a necessary step in the fight against obesity and it’s related morbidities.

Obesity prevalence in Connecticut increased from 10.9% in 1991 to 18.0 % in 2002. Childhood obesity is a major concern as it is a health condition likely to continue into adulthood and to increase the risk of development of type 2 diabetes and cardiovascular disease earlier in life. In New Haven, type 2 diabetes is being diagnosed as young as age 5, and 40% of newly diagnosed cases of diabetes in youth are Type 2. Since problem behaviors or practices significantly involve parental influence and the environment the current project is designed to focus on both of those issues.

Project Design

The Make-a-Difference project is a collaboration between the University of Hartford and the University of Hartford Magnet School. The project is defined in outline form below.

1) The following data will be collected anonymously from every student in the Magnet school and will be analyzed statistically by the University of Hartford students for correlation/causation.

  • Body Mass Index (BMI)
  • age
  • gender
  • race
  • number of days absent from school
  • blood pressure
  • heart rate
  • blood glucose (if possible)Based on the results from the analyses, Magnet school students will be selected for possible inclusion in the study. Candidates will be selected based on BMI (normal, overweight and obese), age, gender and race to establish a balanced study. Up to 50 students will be selected so that each UH student in the course will have a test subject from the Magnet school.

2) Identities of the Magnet school students who agree to participate will never be disclosed to the UH students or any other party unless specifically requested and granted by the test subjects and their families.

3) Letters (see letter) inviting students to participate in the semester long project will be mailed to families by the Magnet school. Students, who in consultation with their families, agree to participate will be asked to do the following over the course of the semester.

  • Keep a diary of their eating routine for 4 days (including over a weekend). This diary will include amounts and time of day when each meal or snack is consumed. These data will be used to calculate total caloric input.
  • Keep a diary of their physical activity/inactivity for 4 days (including over a weekend). This diary will include a description of and amounts of time and time of day for all activity/inactivity.

4) University of Hartford students will also analyze the meals and snacks that are made available to the Magnet school students during a typical school day. Analyses will be used to calculate actual as well as possible caloric input based on what is selected for consumption versus what is available for consumption.

5) In consultation with University of Hartford professors and the Magnet school staff the University of Hartford students will present their research findings at the end of the semester to the families and their children at an evening event. At this event the students will be asked to share/demonstrate what they have learned regarding the benefits of good nutrition, exercise and other behavioral modifications that help to contribute to healthier lifestyles.

6) The University of Hartford professors are offering this course for the first time and intend to make this a yearly course that will continue to work with the Magnet school to benefit both communities. The professors intend to publish/present the results of their study at the Summer Institute for SENCER (Science Education for New Civic Engagements and Responsibilities). The project supervisors agree to acknowledge all appropriate contributors to the study and to protect the anonymity of all test subjects as well as show all completed work to the CREC administration prior to any submission for review for publication consideration.

Related Resources

Text and Assignments

Nutrition, Exercise and Behavior: An Integrated Approach to Weight Management. Liane M. Summerfield, Wadsworth Publishing, 2001.

The text will serve as a resource and must be read prior to lecture. Other readings will be assigned and posted on Blackboard.

Links

Supporting books:

  • Nestle, Marion. Food Politics: How the Food Industry Influences Nutrition and Health. Univeristy of California Press, 2002.
  • Cloutier, M and Adamson, E. The Mediterranean Diet. HarperTorch, 2nd edition. 2004.

Obesity journals:

  • Diabetes, obesity and metabolism
  • International Journal of Obesity
  • Obesity & Diabetes Week
  • Obesity & Health
  • Obesity, Fitness and Wellness Week
  • Obesity Reviews

Supporting film:

  • Supersize Me

Background and Context

Where is the Course Taught?

This course is a part of the University of Hartford’s All-University Curriculum (AUC) which makes clear the relationships among disciplinary areas of
knowledge through integrative, cross-disciplinary courses. These courses also emphasize the development of written and oral communication, critical thinking and problem solving, values identification and independent decision making, social interaction and responsibility for civic life. All freshman who matriculate in baccalaureate programs at the University of Hartford are required to take at least four AUC courses during their four years at the university.

Specifically Issues of Health & Society: Weighing In is a science course with laboratory. It meets the science requirement of the general education curriculum for all non-science majors and so the student population that it serves is multidisciplinary. Although it does meet the science requirement in the general education curriculum for science majors it can be taken as an elective and some science-related departments (i.e., Physical Therapy) have made it a requirement in their curriculum. Ironically, one of the more common comments in student evaluations this year was that this course should be a requirement for all students regardless of their major.

Conclusions and Reflections

To ensure the greatest effect for this course, get to know your students as early in the semester as possible – from the first day, if possible. Learn their backgrounds, their initial interest in the subject matter, and their current fields of study. Once this is established, use this information to guide course management. The students can and should be your best assets to bring this course to its fullest potential. They will come from a widely varied background and academic paths. By bringing this to the forefront, they will be a reflection of the society that the course aims to change.

Effective and engaged learning can be accomplished by allowing the students to feel a certain ownership of their learning. The job of the instructor should be to allow the students to speak freely about their already-held beliefs about obesity, tap into their passions about wellness (everyone wishes for wellness), and unleash their creativity toward a societal and individual solution to ensure health and longevity.

Furthermore, it is highly recommended to seek the alliance of a registered dietitian in this course. Those with degrees in the nutrition sciences are trained to have a full understanding of every aspect that surrounds the complexities of obesity. Also, finding a physiologist with diabetes expertise, neurologist (who can give insight regarding the neurological effects of food chemicals) exercise physiologist, psychologist, and sociologist who have insight into the realm of obesity, weight control and their impact on society will also be very advantageous towards the success of the course. If there are not such individuals working at your institution, reach out to the community to have them guest lecture, etc.