Syllabus

Graduate Programs in Public Health

GPH 734 Obesity Epidemic from a Public Health Perspective – Spring 2019

Credits - 3

Description

Obesity Epidemiology presents current research on the burden of obesity, causes, health consequences, and strategies for prevention within the framework of epidemiology.  Students will gain familiarity with publicly available datasets and research resources as well as methods to assess body composition, dietary intake and physical activity. Students will apply critical thinking informed by course content to critically evaluate studies in obesity epidemiology. Students will also practice skills in data analysis using publically available datasets to analyze the association of lifestyle behaviors with body weight. Prerequisites: GPH 712, GPH 716, GPH 719; Stata statistical software is required for this course.

Materials

  • Hu F. Obesity epidemiology. Oxford University Press; 2008.
  • Stata Data Analysis and Statistical Software, Stata/IC (https://www.stata.com/order/) Must be purchased and downloaded to use in the first week of class. Steps to purchase:
    • Choose your country
    • Click on Student
    • Click on New Purchase
    • You will need at least a 6 month license of Stata/IC

Learning Objectives and Outcomes

Course Outcomes:

  1. Discuss the burden, causes, and consequences of obesity from an epidemiologic perspective.
  2. Compare methods to assess prevalence (body composition) and risk factors of obesity (diet, physical activity, and lifestyle).
  3. Evaluate scientific evidence on changing trends and obesity prevention efforts.
  4. Analyze publicly available population-based data to assess the relationship between obesity and selected risk factors.
  5. Present findings in an appropriate format for a scientific audience.

Master of Public Health Program Competencies

  1. Synthesize and incorporate scientific evidence into professional writing
  2. Search databases and critically analyze peer-reviewed literature   
  3. Develop strategies for  quantitative data management

CEPH Competencies

1. Apply epidemiological methods to the breadth of settings and situations in public health practice

2. Select quantitative and qualitative data collection methods appropriate for a given public health context

3. Analyze quantitative and qualitative data using biostatistics, informatics, computer-based programming and software, as appropriate

4. Interpret results of data analysis for public health research, policy or practice

6. Discuss the means by which structural bias, social inequities and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels

18. Select communication strategies for different audiences and sectors

19. Communicate audience-appropriate public health content, both in writing and through oral presentation

Assignments

Discussion Board: Each week you will be asked to respond to a prompt, and foster discussion by responding to at least one response by a classmate. This is intended to help you think more critically about the readings and lectures. Your initial response should be substantive and should be 250-500 words.  

Please post your initial post by Sunday at 11:59 pm ET. Responses should be posted by Wednesday at 11:59 pm ET. 

Quizzes: Students will complete a quiz in Week 3 focusing on Population Attributable Risk (PAR). In Week 4, students will complete a quiz focusing on Anthropometry Methods. 

BRFSS Data Analysis Assignments: In these assignments, you will be performing guided data analysis to assess the association between Sugar-Sweetened Beverage (SSB) consumption and BMI, and submitting the results step-by-step in weeks 1-6. The data analysis assignments will provide practice in data cleaning, complex survey weighting, simple and multiple linear regression, creating data tables, and detailing the methods, results and conclusion of the data analysis study.

Final Project: BRFSS Data Analysis Slide and Oral Presentation: In this culminating assignment, you will submit completed and corrected data tables for your data analysis project, a slide presentation of your results, and a brief video recording presenting the results and your proposed intervention posted to YouTube. 

Grading Policy

Your grade in this course will be determined by the following criteria:

Grade Breakdown

Discussion Board 1 (4 pts), 4 (5 pts), 1 (6 pts), 1 (7 pts), 1 (10 pts)47 pts
BRFSS Weekly Assignments 1 (2 pts), 2 (3 pts), 1 (5 pts), 2 (10 pts)40 pts
Final Project 10 pts
Quizzes (1 @ 1 point, 1 @ 2 pts)3 pts
Total100%

Schedule

Course Weeks

Week 1: Jan 2 – Jan 9

Week 2: Jan 9 – Jan 16

Week 3: Jan 16 – Jan 23

Week 4: Jan 23  – Jan 30

Week 5: Jan 30 – Feb 6

Week 6: Feb 6 – Feb 13

Week 7: Feb 13 – Feb 20

Week 8: Feb 20 – Feb 24

Week 1: Introduction to Obesity Epidemiology and Data Analysis

Learning Outcomes

  • Discuss the contribution of epidemiology to obesity research and prevention
  • Describe the burden of obesity in the US and globally
  • Discuss the key sequelae of rising rates of obesity in terms of health outcomes and quality of life
  • Describe the Behavioral Risk Factor Surveillance Survey (BRFSS) from the Centers for Disease Control (CDC)

Lectures

  • 1.1 Welcome 
  • 1.2 Introduction to Obesity Epidemiology     
  • 1.3 Obesity prevalence and burden of disease    
  • 1.4 Data analysis tutorial – Intro to BRFSS and Final Project     

Data Analysis Tutorial Videos:

  • Video Tutorial 1: Download and unzip BRFSS 2016 data file
  • Video Tutorial 2: Import SAS XPORT file
  • Video Tutorial 3: Create Stata DO file and run Week 1 code

Reading and Other Media:

  • Textbook Chapter 1: Introduction to Obesity Epidemiology
  • Textbook Chapter 2: Descriptive Epidemiology of Obesity Trends, pgs. 15-16
  • Gurka MJ, Filipp SL, DeBoer MD. Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutr Diabetes. 2018;8(1):14  .
  • Final Project Instructions
  • CDC Behavioral Risk Factor Surveillance System webpages:
  • BRFSS: https://www.cdc.gov/brfss/
  • About Pages: 
    • https://www.cdc.gov/brfss/about/index.htm
    • https://www.cdc.gov/brfss/about/brfss_today.htm
  • FAQs: https://www.cdc.gov/brfss/about/brfss_faq.htm
  • Skim to gain familiarity: BRFSS User Guide linked from this page: https://www.cdc.gov/brfss/data_documentation/index.htm

Recommended Resources:

  • Gu JK, Charles LE, Bang KM, et al. Prevalence of obesity by occupation among US workers: the National Health Interview Survey 2004-2011. J Occup Environ Med. 2014;56(5):516-528 

Assignments

We will begin the course with personal and professional introductions.

For your initial post: Please share something about your background, your interests and goals in the field of public health, and what you hope to get out of this class.

To describe your interest in obesity research, provide a 200-300 word piece of background writing on the burden of obesity in the US. Report on obesity rates within a specific demographic subgroup of gender, age, race, ethnicity, or SES, based on your interest. Be sure to frame the statistics and prevalence for your subgroup in the context of the national statistics. What issues arise for obesity prevalence and prevention relevant to this specific population?  Please use AMA format for references. Aim for 5-6 peer-reviewed, current (<5 yrs old) references.

In your response post: Compare the subgroup you chose to one chosen by a classmate. What commonalities or differences exist? What are some important considerations for researchers in regards to these groups, and how does this information affect your own professional goals?

  • Week 1 BRFSS Data Analysis Assignment

This week you will begin the process of data analysis for your Final Project. The specific aim for the analysis will be to assess the association of BMI and sugar-sweetened beverage consumption using the Behavioral Risk Factor Surveillance System (BRFSS) 2016 data for the state of New York.

This assignment requires you to include screenshots as evidence of your data analysis work this week. Please be sure that the screenshots are clear and legible so that your instructor can view them, and that they contain all of the required elements described in the assignment instructions. Here is a resource if you need help creating screenshots on a Mac or a PC. You will submit your assignment as a Word document with the screenshots pasted into it.

Week 1 Assignment Instructions

__________________________________________________________

Week 2: Risk Factors of Obesity and Overweight

Learning Outcomes

  • Identify risk factors for obesity and overweight
  • Discuss health disparities of obesity and overweight in terms of age, sex, race, and socioeconomic status
  • Discuss the roles of diet and physical activity on weight statusIdentify characteristics of the built environment that promote overeating
  • Distinguish the relative influence of individual characteristics and lifestyle factors on weight status
  • Perform data cleaning as part of linear regression analysis

Data Analysis Tutorial Videos:

  • Week 2 Video Tutorial: Run BRFSS code

Reading and Other Media:

  • Textbook Chapter 14: Diet, Nutrition, and Obesity
  • Textbook Chapter 15: Physical Activity, Sedentary Behaviors, and Obesity
  • Cohen DA. Obesity and the built environment: changes in environmental cues cause energy imbalances. Int J Obes (Lond). 2008;32 Suppl 7 :S137-142.
  • Vreman RA, Goodell AJ, Rodriguez LA, Porco TC, Lustig RH, Kahn JG. Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model. BMJ Open. 2017;7(8):e013543

To continue our data analysis for the Final Project, please review the BRFSS documentation files you downloaded last week to gain familiarity with the dataset, codebook, and weighting variables. It’s not necessary to read them in detail, but you should read the beginnings and skim to orient yourself to the content. Note that while we will not be using any of the calculated variables in our analysis, there are differences in variable naming between collected variables and calculated variables.

  • 2016 BRFSS Overview
  • 2016 BRFSS Codebook
  • Calculated Variables in Data Files
  • 2016 Weighting Formula

Recommended Resources:

  • Textbook Chapter 16: Sleep Deprivation and Obesity 
  • Textbook Chapter 17: Social Determinants of Obesity
  • Agurs-Collins T, Khoury MJ, Simon-Morton D, Olster DH, Harris JR, Milner JA. Public health genomics: translating obesity genomicsresearch into population health benefits. Obesity (Silver Spring). 2008;16 Suppl 3 :S85-94.
  • Loewenstein G, Brennan T, Volpp KG. Asymmetric paternalism to improve health behaviors. JAMA. 2007;298(20):2415-2417
  • Anzman-Frasca S, Mueller MP, Sliwa S, et al. Changes in children’s meal orders following healthy menu modifications at a regional U.S. restaurant chain. Obesity (Silver Spring). 2015;23(5):1055-1062
  • Santos I, Sniehotta FF, Marques MM, Carraca EV, Teixeira PJ. Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis. Obes Rev. 2017;18(1):32-5

Lectures

  • 2.1 Individual risk factors for obesity  
  • 2.2 Diet, physical activity, and body weight  
  • 2.3 The built environment    
  • 2.4 Data cleaning tutorial    

Assignments

  • Discussion: The Built Environment

    This week we look at the intersecting dynamics that together increase or decrease risk for obesity.

    Initial Post: Find one peer-reviewed research paper on the built environment and discuss its main findings and implications for obesity risk. The article you select should be recent (published in the last 5 years) and should be a new source (not included in the class materials). Consider your personal experiences with regard to diet, physical activity, and the built environment. How does this paper, and the research presented in the lectures and readings, align or contrast with your own experience?

Response Post: In your response to a classmate, discuss your own thoughts about the research they presented and the challenges described. Present additional research with results that demonstrate a risk reduction for overweight/obesity (from an observational study), or an intervention that successfully produced changes in body weight. How would you apply these results in a broad context to address overweight/obesity on a population scale?

  • Week 2 BRFSS Data Analysis Assignment

This week you will continue work on your data analysis by cleaning your BRFSS data. Data cleaning is always the most tedious part of the analysis process, and often takes much longer than expected. Starting the data cleaning process well-ahead is an important practice in avoiding binge analysis, which tends to lead to mistakes. 

Week 2 Assignment Instructions

__________________________________________________________

Week 3: Analytic Design and Causal Inference in the Study of Obesity

Learning Outcomes

  • Discuss the best uses and limitations of the following study designs in the context of obesity research:
    • Ecological studies
    • Cross-sectional
    • Case-control
    • Cohort studies
    • Randomized controlled trials (RCTs)
  • Identify threats to internal validity of research studies
  • Distinguish between validity and generalizability
  • Define population attributable risk (PAR) and methods of calculation
  • Discuss best practices in drawing causal inferences from epidemiological research
  • Apply complex survey weighting and run a simple and multiple linear regression analysis

Data Analysis Tutorial Videos:

  • Week 3 Video Tutorial: Run BRFSS code

Reading and Other Media:

  • Chapter 3: Analytic Epidemiologic Designs in Obesity Research
  • Chapter 4: Interpreting Epidemiologic Evidence and Causal Inference in Obesity Research
  • Frieden TR. Evidence for health decision making—beyond randomized, controlled trials. N Engl J Med. 2017;377(5):465-475
  • Nimon KF. Statistical assumptions of substantive analyses across the general linear model: a mini-review. Front Psychol. 2012;3:322

Lectures

  • 3.1 Research Design in Obesity Epidemiology  
  • 3.2 Part I –  Causal Inference and interpreting epidemiologic evidence
  • 3.2 Part II –  Causal Inference and interpreting epidemiologic evidence
  • 3.3 Data analysis tutorial – Complex Survey Weighting 
  • 3.4 Interpreting Quantitative Measures Refresher

Assignments

  • Discussion: Appropriate Choice of Study Design

This week we explore the strengths and limitations of various study designs and their relevance in obesity research. Building on the material last week on the built environment, complete the Study Design Chart  

to apply your knowledge of study design and causal inference to topics in obesity research.

Please be sure you are using RefWorks for citation management. If you haven’t already set up your RefWorks account or need a quick guide to adding sources and making citations, please see the RefWorks Support page.

Initial Post: Share your completed Study Design Chart along with your comments about the study design you would choose if you were conducting research on the built environment and outcomes of overweight/obesity. Propose a research question with an exposure and outcome, as well as the study design you would choose. Describe a study that could be conducted that would make appropriate use of this design’s strengths and limitations.

Note: This Discussion requires two response posts:

1st Response Post: Provide feedback to a classmate on their Study Design selection and offer constructive criticism and additional considerations with respect to the validity or generalizability of the results.     

2nd Response Post: Discuss any thoughts you have around your choice of study design and possible revisions to your proposal based on your classmate’s feedback.

  • Week 3 BRFSS Data Analysis Assignment

    This week we will take the next steps in data analysis in the context of discussing analytic design and causal inference. Last week you selected your variables, cleaned the data, and created a new variable, include, that you can use to take a subsample to run your analysis. This week you will begin to set up your analysis so that next week we can check the assumptions of linear regression. Because BRFSS uses complex survey weighting, our work this week is simply to run the initial models using complex survey weight variable.

    Week 3 Assignment Instructions

  • Week 3 Quiz: Population Attrituable Risk (PAR)

__________________________________________________________

Week 4: Methods to Assess Body Composition

Learning Outcomes

  • Identify methods of assessment of body composition, including: 
    • Reference methods 
    • Anthropometry
  • Define commonly used weight variables in epidemiologic research
  • Define adiposity and body mass index (BMI)
  • Discuss issues of validity, including under- and over-reporting of height and weight
  • Check assumptions of linear regression

Lectures

  • 4.1 Reference methods for measuring body composition  
  • 4.2 Field methods for measuring body composition   
  • 4.3 Data analysis tutorial: assumptions of linear regression   

Data Analysis Tutorial Videos:

  • Week 4 Video Tutorial: Run BRFSS code

Reading and Other Media:

  • Chapter 5: Measurements of Adiposity and Body Composition.
  • Mozumdar A, Liguori G. Corrective Equations to Self-Reported Height and Weight for Obesity Estimates Among U.S. Adults: NHANES 1999-2008. Res Q Exerc Sport. 2016;87(1):47-58
  • Cui Z, Stevens J, Truesdale KP, Zeng D, French S, Gordon-Larsen P. Prediction of Body Mass Index Using Concurrently Self-Reported or Previously Measured Height and Weight. PLoS One. 2016;11(11):e0167288

Assignments

  • Discussion: Validity of Self-Reported Data

The validity of self-reported data is an issue in all research, but particularly with respect to height and weight.

Initial Post: Choose an outside paper to present to the class that examines issues of validity of self-reported height and weight data within a specific sub-group. Summarize the methods and key findings, and discuss your assessment of the researcher’s decisions or conclusions. How can the findings of this paper be applied to future research to improve the validity of these measures? What special considerations related to the sub-group should researchers take into account?

Response Post: Compare the findings in the paper you selected to the findings presented by one of your classmates. How do these groups differ with respect to underreporting or overestimating? Are there different issues raised within different subgroups? Are there different strategies researchers need to apply to mitigate issues of the validity of self-reported data in these populations?

  • Assignment: Week 4 BRFSS Data Analysis Assignment

Now that you have run your regression models using the weighting variables, we can examine them to check if they violate the assumptions of linear regression. If we find any violations, we may need to transform the relevant variables and then re-run the regression to check whether or not those transformations addressed the problem.

Week 4 Assignment Instructions

  • Quiz: Anthropometry Methods

__________________________________________________________

Week 5: Methods of Dietary Assessment

Learning Outcomes

  • Identify methods of dietary assessment and describe strengths and limitations of each method as compared to the gold standards for dietary assessment
  • Discuss biomarkers of dietary intake and their application for validation of other dietary assessments
  • Practice use of 24-hour recalls and food frequency questionnaires to gain firsthand experience of their applications
  • Discuss the importance of refining methods of dietary assessment for specific target populations
  • Create polished results tables using analysis data

Data Analysis Tutorial Videos:

  • Week 5 Video Tutorial: Run BRFSS code

Reading and Other Media:

  • Chapter 6:  Dietary Assessment Methods
  • Stote KS, Radecki SV, Moshfegh AJ, Ingwersen LA, Baer DJ. The number of 24 h dietary recalls using the US Department of Agriculture’s automated multiple-pass method required to estimate nutrient intake in overweight and obese adults. Public Health Nutr.2011;14(10):1736-1742.
  • Yuan C, Spiegelman D, Rimm EB, et al. Relative Validity of Nutrient Intakes Assessed by Questionnaire, 24-Hour Recalls, and Diet Records Compared With Urinary Recovery and Plasma Concentration Biomarkers: Findings for Women. Am J Epidemiol. 2017.
  • Dragsted LO, Gao Q, Pratico G, et al. Dietary and health biomarkers-time for an update. Genes Nutr. 2017;12:24.
  • Skim for familiarity: Homepage of the ASA24, the online 24-hour recall from the National Cancer Institute (NCI)
  • Skim for familiarity: Homepage of the DHQ, the online food frequency questionnaire (FFQ) from the National Cancer Institute (NCI)

Recommended Resources:

  • Murakami K, Livingstone MB. Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012. Br J Nutr. 2015;114(8):1294-1303
  • Pratico G, Gao Q, Scalbert A, et al. Guidelines for Biomarker of Food Intake Reviews (BFIRev): how to conduct an extensive literature search for biomarker of food intake discovery. Genes Nutr.2018;13:3.
  • Lovell A, Bulloch R, Wall CR, Grant CC. Quality of food-frequency questionnaire validation studies in the dietary assessment of children aged 12 to 36 months: a systematic literature review. Journal of nutritional science. 2017;6:e1
  • Whitton C, Ho JCY, Tay Z, et al. Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Intakes in a Multi-Ethnic Asian Population Using 24-h Dietary Recalls and Biomarkers. Nutrients. 2017;9(10)

Lectures

  • 5.1 Methods of Dietary Assessment  
  • 5.2 Biomarkers   
  • 5.3 Data Analysis Tutorial: Creating Polished Data Tables  

Assignments

  • Discussion: 24-Hour Recalls vs. Food Frequency Questionnaires

This week we examine methods of dietary assessment and consider their strengths and limitations. 

Initial Post: Discuss the best uses for a 24-hr recall vs. food frequency questionnaire, with examples of outside, peer-reviewed papers supporting your statements. Be sure to provide examples of appropriate use of each tool for different research questions. You will be able to see your classmates’ posts after you share your initial post.

Response post: Before submitting your response post, complete the two demonstration questionnaires (the ASA24 and the DHQ-II) described in this week’s assignment instructions. Share your observations about your experience in reference to your and your classmates’ discussion of the strengths and limitations of different methods of dietary assessment. How did you feel about the tools? How does your personal experience compare to what we know about the validity of these dietary assessment tools, and their strengths and limitations? Be sure the opinions you present are informed statements supported by research results.

  • Assignment: Dietary Assessment Demonstrations

Complete the demonstration questionnaire for the ASA-24 2016, an online 24-hour recall available to researchers for free from the National Cancer Institute. Please take a 3 screenshots throughout the process and submit the screenshots as proof of completion. Be sure to select the first option: “ASA-24 2016”

Complete the demonstration questionnaire for the DHQ-II, an online FFQ available to researchers for free from the National Cancer Institute. Under Web-based DHQ II, click on “Demo” to access the demonstration site.

Please take three screenshots throughout the process and submit the screenshots as proof of completion. 
Paste all 6 of your screenshots into a Word document and upload the Word document to Blackboard. 

  • Assignment: Week 5 BRFSS Data Analysis Assignment

Week 5 Assignment Overview: In previous weeks you have cleaned your data and run regression models. This week you will create results tables and present your data. 

Week 5 Assignment Instructions

__________________________________________________________

Week 6:  Methods to Assess Physical Activity

Learning Outcomes

  • List and describe self-reported and objective measures of physical activity
  • Discuss strengths and limitations of different physical activity measures
  • Discuss the unique contribution and limitations of smartphone apps as an emerging technology

Reading and Other Media:

  • Textbook Chapter 7: Physical Activity Measurements
  • de Vries HJ, Kooiman TJ, van Ittersum MW, van Brussel M, de Groot M. Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis. Obesity (Silver Spring). 2016;24(10):2078-2091
  • Schoeppe S, Alley S, Van Lippevelde W, et al. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour : a systematic review. Int J Behav Nutr Phys Act. 2016;13(1):12

Recommended Resources:

  • Evenson KR, Goto MM, Furberg RD. Systematic review of the validity and reliability of consumer-wearable activity trackers. nt J Behav Nutr Phys Act.2015;12.
  • Goode, A. P., Hall, K. S., Batch, B. C., Huffman, K. M., Hastings, S. N., Allen, K. D., . . . Gierisch, J. M. (2017). The impact of interventions that integrate accelerometers on physical activity and weight loss: A systematic review. Annals of Behavioral Medicine,51(1), 79-93 
  • McCallum C, Rooksby J, Gray CM. Evaluating the Impact of Physical Activity Apps and Wearables: Interdisciplinary Review. JMIR mHealth and  uHealth 2018;6(3):e58

Lectures

  • 6.1 Measuring Physical Activity and Objective Methodologies 
  • 6.2 Self Reported Methods and Emerging Technologies 
  • 6.3  Data analysis tutorial: scientific writing 

Assignments

  • Discussion: Emerging Technologies for Tracking Physical Activity

Your reading this week includes two systematic reviews on the use of wearable physical activity monitors (such as FitBits or other devices) and smartphone apps to improve diet, physical activity, and sedentary behavior in health research and interventions.

Overall, results were mixed. There is evidence that monitors and smartphone apps can change behavior, but the evidence is less consistent that use of these devices is predictive of changes in health outcomes.

For your initial post, choose one of the interventions included in one of the systematic reviews, and provide a critique of its effectiveness that is informed by the overall results from the systematic review it came from. Be sure to reference the original paper cited in the review that you select. In your critique, address the methods/tools selected, the contact and feedback provided to participants, follow-up, and how and what outcomes were measured.  Consider how an intervention context differs from an observational study, in which changing behavior may not be desirable.

In your reply post, compare the interventions selected by your classmate to the one you selected and provide comments on their relative strengths and limitations. What do you see as the next steps for use of these emerging technologies in the field of physical activity research?

  • Week 6 BRFSS Data Analysis Assignment

The culmination of your work investigating the association between SSB consumption and BMI in the state of New York is the opportunity to report on your results. Last week you created results tables. This week you will complete a write-up of several of the sections you would need to write if you were going to submit this analysis to a peer-reviewed journal. These sections include: methods, results, and conclusion. This material is part of what you will present in your video presentation as part of the Final Project due in Week 8.

Week 6 Assignment Instructions 

__________________________________________________________

Week 7: Consequences of Obesity

Learning Outcomes

  • Discuss the metabolic consequences of obesity and associated comorbidities, including:
    • Metabolic syndrome
    • Cardiovascular disease
    • Type 2 diabetes
    • Cancer
  • Describe the consequences of obesity on quality of life and subjective experiences of well-being
  • Discuss the economic burden of obesity and associated chronic disease in the US
  • Describe complex causal pathways implicated in the development of obesity and related sequelae thought the creation of a conceptual model

Reading and Other Media:

  • Chapter 8: Metabolic Consequences of Obesity
  • Chapter 11: Obesity and Mortality
  • Conceptual Models: Evidence-Informed Decision Making

Choose one of Chapters 9, 10, 12 or 13 listed below:

  • Chapter 9: Obesity and Cardiovascular Disease
  • Chapter 10: Obesity and Cancer
  • Chapter 12: Obesity and Health-Related Quality of Life
  • Chapter 13: Economic Costs of Obesity

Choose one of the following that corresponds to the textbook chapter you selected

  • Medina-Inojosa JR, Somers VK, Thomas RJ, et al. Association Between Adiposity and Lean Mass With Long-Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox. J Am Heart Assoc. 2018;7(10).
  • Aleksandrova K, Jenab M, Leitzmann M, et al. Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort. Int J Epidemiol. 2017;46(6):1823-1835.
  • Ul-Haq Z, Mackay DF, Fenwick E, Pell JP. Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obesity (Silver Spring). 2013;21(3):E322-327.
  • Wang YC, Pamplin J, Long MW, Ward ZJ, Gortmaker SL, Andreyeva T. Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013. Health Aff (Millwood). 2015;34(11):1923-1931.

Lectures

  • 7.1 Consequences of Obesity 
  • 7.2 How to create a conceptual model
  • 7.3 Tips for the Final Project 

Assignments

  • Discussion: Illustrating Causes and Consequences of Obesity Through Conceptual Models

You have spent the last several weeks learning about the causes of obesity. This week we examine some of the consequences. The full range of consequences is so broad that it is not possible to cover them all in this course. Your reading this week asks you to choose one of the textbook chapters on the consequences of obesity, either cardiovascular disease, cancer, health-related quality of life, or the economic costs of obesity. Refer to your selected textbook chapter for your discussion post this week. 

Note: This Discussion requires one initial post and two response posts. For this discussion, you will view your classmates’ work, and give and respond to the feedback given to you by a classmate. In order for this discussion to be successful, it is critical that you submit your initial and response posts on time (see due dates in module).

Initial Post: Create a conceptual model that illustrates the risk factors in the development of obesity and the resulting consequences that you chose to focus on in your reading. The goal is to illustrate the way the exposure-outcome relationship works based on your understanding of the complex dynamics. Your conceptual model should be accompanied by an explanatory title summarizing what it is expressing. A strong conceptual model will stand on its own and be largely understandable to someone without much explanatory text. In creating the model, you should draw from what we have covered in previous weeks, especially Week 2.

Include 2-3 paragraphs that summarize the burden of the consequences of obesity that you chose to focus on this week. Also, include some mention of why you were personally drawn to this particular consequence of obesity,

Response posts: Offer feedback to this classmate on their conceptual model and text, and discuss any questions or points of confusion you have regarding what the model illustrates, or provide suggestions for clarification. In your second response Post, reflect on the feedback you received from a classmate, and share any new thoughts you have about your own conceptual model in comparison to your classmates. How might you edit and make the model more effective? Can you identify any instances in which you can plan to use your model?

Week 8: Public Health Prevention of Obesity

Learning Outcomes

  • Discuss population-based prevention efforts to reduce the prevalence of overweight and obesity
  • Identify the elements of effective interventions for weight loss
  • Describe the Social-Ecological Model (SEM) and its application to obesity prevention
  • Identify determinants of adherence to dietary and physical activity changes within the SEM
  • Present findings in a format appropriate for an audience of professional peers. 

Reading and Other Media:

  • Wetter AC, Goldberg JP, King AC, et al. How and why do individuals make food and physical activity choices? Nutr Rev. 2001;59(3) :S11-S20.
  • Dietz WH. The response of the US Centers for Disease Control and Prevention to the obesity epidemic. Annu Rev Public Health. 2015;36:575-596.
  • Sisnowski J, Street JM, Merlin T. Improving food environments and tackling obesity: A realist systematic review of the policy success of regulatory interventions targeting population nutrition. PLoS One. 2017;12(8):e0182581
  • Kumar GS, Pan L, Park S, et al. Sugar-sweetened beverage consumption among adults — 18 states, 2012. MMWR Morb Mortal Wkly Rep. 2014;63(32):686-690.
  • Turner-McGrievy GM, Davidson CR, Wingard EE, Wilcox S, Frongillo EA. Comparative effectiveness of plant-based diets for weight loss: A randomized controlled trial of five different diets. Nutrition. 2015;31(2):350-358.

Recommended Resources:

  • Harvard School of Public Health Obesity Prevention Strategiesand all subpages, including Families, Early Child Care, Schools, Health Care, Worksites, Healthy Food Environment, Healthy Activity Environment
  • Wang YQ, Zhang YQ, Zhang F, Zhang YW, Li R, Chen GX. Increased Eating Frequency Is Associated with Lower Obesity Risk, But Higher Energy Intake in Adults: A Meta-Analysis. Int J Environ Res Public Health. 2016;13(6).

Lectures

  • 8.1 The Social-Ecological Model   
  • 8.2 Predictors of Successful Weight Loss   
  • 8.3 Population-based Obesity Prevention  

Assignments

  • Discussion: Data Analysis Presentation Critique

This is the final week of our course, concluding with your submission of your Final Project documents and video presentation. Your presentation will include the methods, results, and conclusion of your data analysis, as well as your proposed research intervention to reduce SSB consumption in the state of New York. 

For this discussion, you will have an opportunity to view one another’s presentations and give and receive feedback on the work. In order for this discussion to be successful, it is critical that you submit your initial and response posts on time (remember, this is a shortened week, so these discussions have an early deadline). 

Initial post:  Share a link to your YouTube video. Include a more developed description of the research intervention you propose as background for your oral description in the presentation. Your intervention should identify one or multiple levels of influence from the SEM at which to intervene for the purpose of reducing SSB consumption as a means of obesity prevention.  In the description of your intervention, be sure to describe your target population, the goal of the intervention, justification for the specific study design you choose, objective measures to assess its effectiveness, and any plans for ongoing evaluation and monitoring. Be sure to frame your intervention in the context of what has already been done or attempted in New York. 

Response post: Select one classmate’s post that does not already have a reply. In your response post, evaluate their slides, video presentation, and proposed research intervention. In your evaluation, provide qualitative feedback/commentary on their delivery and the proposed intervention from the perspective of a professional colleague. Share any questions or points of confusion you have, and remember to also give complementary, professional feedback.

  • Assignment: BRFSS Data Analysis Final Project

The purpose of this assignment is to allow you to practice the skills you have gained throughout the course in assessing and analyzing the association of a dietary risk factor with risk of obesity, and to present your results and a proposed intervention to an audience of your professional peers. The culminating assignment is a three-part Final Project in which you will submit your data files, a slide presentation of your results, and a brief video recording of your results and your proposed intervention.

Week 8 Final Project Assignment Instructions

Student Resources

Online Student Support

Your Student Support Specialist is a resource for you. Please don't hesitate to contact them for assistance, including, but not limited to course planning, current problems or issues in a course, technology concerns, or personal emergencies.

Questions? Visit the Student Support Public Health page

UNE Libraries:

UNE Student Academic Success Center

UNE's Student Academic Success Center (SASC) offers a range of free online services to support your academic achievement. Writing support, ESOL support, study strategy and learning style consultations, as well as downloadable resources, are available to all matriculating students. The SASC also offers tutoring for GPH 712 Epidemiology, GPH 716 Biostatistics, GPH 717 Applied Epidemiology, GPH 718 Biostatistics II, and GPH 719 Research Methods. To make an appointment for any of these services, go to une.tutortrac.com. For more information and to view and download writing and studying resources, please visit:

Information Technology Services (ITS)

  • ITS Contact: Toll Free Help Desk 24 hours/7 days per week at 1-877-518-4673

Accommodations

Any student who would like to request, or ask any questions regarding, academic adjustments or accommodations must contact the Student Access Center at (207) 221-4438 or pcstudentaccess@une.edu. Student Access Center staff will evaluate the student's documentation and determine eligibility of accommodation(s) through the Student Access Center registration procedure.

Online Peer Support

Togetherall is a 24/7 communication and emotional support platform monitored by trained clinicians. It’s a safe place online to get things off your chest, have conversations, express yourself creatively, and learn how to manage your mental health. If sharing isn’t your thing, Togetherall has other tools and courses to help you look after yourself with plenty of resources to explore. Whether you’re struggling to cope, feeling low, or just need a place to talk, Togetherall can help you explore your feelings in a safe supportive environment. You can join Togetherall using your UNE email address.

Information Technology Services (ITS)

Students should notify their Student Support Specialist and instructor in the event of a problem relating to a course. This notification should occur promptly and proactively to support timely resolution.

ITS Contact: Toll-Free Help Desk 24 hours/7 days per week at 1-877-518-4673.

Career Ready Program

The College of Professional Studies supports its online students and alumni in their career journey!

The Career Ready Program provides tools and resources to help students explore and hone in on their career goals, search for jobs, create and improve professional documents, build professional network, learn interview skills, grow as a professional, and more. Come back often, at any time, as you move through your journey from career readiness as a student to career growth, satisfaction, and success as alumni.

Policies

AMA Writing Style Statement

The American Medical Association Manual (AMA) of Style, 11th edition is the required writing format for this course. Additional support for academic writing and AMA format is provided throughout the coursework as well as at the UNE Portal for Online Students.

Online resources: AMA Style Guide

Turnitin Originality Check and Plagiarism Detection Tool

The College of Professional Studies uses Turnitin to help deter plagiarism and to foster the proper attribution of sources. Turnitin provides comparative reports for submitted assignments that reflect similarities in other written works. This can include, but is not limited to, previously submitted assignments, internet articles, research journals, and academic databases.

Make sure to cite your sources appropriately as well as use your own words in synthesizing information from published literature. Webinars and workshops, included early in your coursework, will help guide best practices in APA citation and academic writing.

You can learn more about Turnitin in the guide on how to navigate your Similarity Report.

Technology Requirements

Please review the technical requirements for UNE Online Graduate Programs: Technical Requirements

Course Evaluation Policy

Course surveys are one of the most important tools that University of New England uses for evaluating the quality of your education, and for providing meaningful feedback to instructors on their teaching. In order to assure that the feedback is both comprehensive and precise, we need to receive it from each student for each course. Evaluation access is distributed via UNE email at the beginning of the last week of the course.

Late Policy

Students are responsible for submitting work by the date indicated in Brightspace.

Quizzes and Tests: Quizzes and tests must be completed by the due date. They will not be accepted after the due date.

Assignments: Unless otherwise specified, assignments will be accepted up to 3 days late; however, there is a 10% grade reduction (from the total points) for the late submission. After three days the assignment will not be accepted.

Discussion posts: If the initial post is submitted late, but still within the discussion board week, there will be a 10% grade reduction from the total discussion grade (e.g., a 3 point discussion will be reduced by 0.3 points). Any posts submitted after the end of the Discussion Board week will not be graded.

Please make every effort ahead of time to contact your instructor and your student support specialist if you are not able to meet an assignment deadline. Arrangements for extenuating circumstances may be considered by faculty.

Student Handbook Online - Policies and Procedures

The policies contained within this document apply to all students in the College of Graduate and Professional Studies. It is each student's responsibility to know the contents of this handbook.

Student Handbook

UNE Course Withdrawal

Please contact your student support specialist if you are considering dropping or withdrawing from a course. The last day to drop for 100% tuition refund is the 2nd day of the course. Financial Aid charges may still apply. Students using Financial Aid should contact the Financial Aid Office prior to withdrawing from a course.

Academic Integrity

The University of New England values academic integrity in all aspects of the educational experience. Academic dishonesty in any form undermines this standard and devalues the original contributions of others. It is the responsibility of all members of the University community to actively uphold the integrity of the academy; failure to act, for any reason, is not acceptable. For information about plagiarism and academic misconduct, please visit https://www.une.edu/studentlife/plagiarism.

Academic dishonesty includes, but is not limited to the following:

  1. Cheating, copying, or the offering or receiving of unauthorized assistance or information.
  2. Fabrication or falsification of data, results, or sources for papers or reports.
  3. Action which destroys or alters the work of another student.
  4. Multiple submissions of the same paper or report for assignments in more than one course without permission of each instructor.
  5. Plagiarism, the appropriation of records, research, materials, ideas, or the language of other persons or writers and the submission of them as one's own.

Charges of academic dishonesty will be reviewed by the Program Director. Penalties for students found responsible for violations may depend upon the seriousness and circumstances of the violation, the degree of premeditation involved, and/or the student’s previous record of violations.  Appeal of a decision may be made to the Dean whose decision will be final.  Student appeals will take place through the grievance process outlined in the student handbook.