MSEB 418 Obesity Epidemiology 1.0 Credit Quarter Year: Summer 2015 Day/Time: Monday and Wednesday/1:00-3:00 PM Location: IPHAM Classroom at 633 N St. Clair Street, Suite 1800 *June 24 and July 20 class in McGaw 1-401* Instructor: Mercedes Carnethon, Ph.D. Instructor Title: Associate Professor in Preventive Medicine Instructor Contact Email: carnethon@northwestern.edu Office Hours: Wednesdays 3:00-4:00pm COURSE DESCRIPTION The overall objective of this course is to provide students with a broad overview of the origins of obesity, the burden and distribution of obesity in the population and the association of obesity with major chronic diseases and life transitions. Students will discuss each of these concepts while considering the strengths and limitations of using epidemiology as a tool to measure and ultimately prevent disease in the population. LEARNING OBJECTIVES After successful completion of this course, students will be able to: 1. List the various methods of measuring body fat and describe limitations of each method 2. Describe distribution of body weight among populations and trends in weight gain over time 3. Describe the relationship between overweight, obesity and various health outcomes 4. Critically evaluate epidemiologic research on the causes and consequences of obesity 5. Describe developments in obesity prevention over the last thirty years 6. Compare outcomes for behavioral, medical, and surgical interventions used to treat obesity 7. Explain advantages and limitations of observational and intervention obesity study designs Course concepts will be taught through a combination of lectures, in-class group-based activities and activities that take place in class but require preparation prior to class. TEXTS AND READINGS The required textbook for the course is Obesity Epidemiology by Frank Hu, Oxford University Press 2008. Additional required readings from contemporary journal articles are posted on the course management system. BLACKBOARD TM /COURSE MANAGEMENT SYSTEM The syllabus and selected readings will be posted on the course s management system website, available at https://courses.northwestern.edu/webapps/login/ if you are registered for the course. STUDENT EVALUATION: Presentation of a critical research question: At the final class session (may change depending on the size of the class) before the final, you will give an individual 10-minute oral presentation using slides that describes a critical issue in obesity epidemiology today and proposes a research study to address that question. A brief 3-4 sentence description of the critical issue that you intend to pursue should be submitted to the instructor via the course management system on July 20 for approval. You may change your proposed topic, but all updates must be approved by the instructor prior to presentation. Your presentation will be evaluated based on your ability to clearly define a significant research question, provide a rationale justifying the importance of the question, and present a research study using an appropriate design that can address the question. The research study to address the question should use an epidemiologic approach and can be either observational or an intervention. Strengths and limitations of the proposed research study should be discussed. The presentation should conclude with an overall impact statement that addresses the contribution that the proposed study can make towards advancing the research field. A grading rubric for the presentation is available on the course management system. Because the instructor is not available to preview the presentation for content or delivery 1 P age
prior to the presentation date, you are encouraged to share your presentations with a peer in the class for feedback. Comprehensive final examination: Through a combination of multiple-choice and short answer questions you are expected to demonstrate mastery of all concepts that were covered in the course. The majority of material that you will be tested on will come from the primary textbook for the course, Obesity Epidemiology. The final exam will either be a take-home examination or an in class examination, depending on the preferences of the class (vote to decide on July 15). Full Class Debate: On July 13 th, the class will engage in a debate on the topic to discuss whether physical activity or nutrition is more important for weight loss or weight maintenance. The class will be divided into four groups who will argue 4 unique positions: 1) physical activity is more appropriate for weight loss; 2) physical activity is more useful for weight maintenance; 3) diet is more important for weight loss; and, 4) diet is more important for weight maintenance. The debate is expected to be presented in the form of a panel presentation where each party has 15 minutes to make its initial argument all four groups will rotate through the initial argument. Then, each party will have an opportunity for a 5 minute rebuttal. Clearly organized PowerPoint slides are expected for the initial argument and can be used for the rebuttal as well. The debate will end with an open discussion among the class. Ideally, each member of the group will contribute to the presentation or the rebuttal. Each group is required to submit a written summary of their arguments and at least one anticipated counter argument. The written summary should be a maximum of six double-spaced pages and should include contemporary citations to the support the argument. All members of the group will receive a single grade for the written document. You will be asked to complete a peer evaluation of the contribution of each of your group members to the learning process. If a team member is noted by more than one group member not to have contributed to the group process, the instructor reserves the right to modify his/her grade from that received by the remainder of the group. A grading rubric for the written assignment is available on the course management system. Class participation: In order to enhance the learning environment for everyone, you are expected to complete readings prior to class and engage in thoughtful class discussions by posing questions and volunteering answers. If you have a mobile computing device (laptop or tablet computer) that has a wireless connection, please bring it to the sessions denoted by laptops needed. However, laptops are not required for this course so if you do not have one, you do not need to purchase one. At least one laptop is required per group and if you do not have one, you can be paired with a team that has one. Regular attendance is a critical component to learning. If you anticipate missing more than class and know in advance, please notify the instructor. There is one large group project (the debate) and a number of targeted class discussions. Each of these activities is group based and so your classmates depend on your presence. If you are not able to attend and do not provide any advanced notice to your team members and do not have a very valid excuse for your absence, you will receive zero points for that activity. Targeted Class Discussion (TCD): The goal of the targeted class discussion (TCD) is to debate the findings of two journal articles that have come to different conclusions about an important issue in obesity epidemiology. The entire class is expected to have read both articles. Two student groups comprised of 3 to 4 students are assigned to lead the discussion. Each group will prepare discussion points that highlight the strengths and weaknesses of their assigned article, which they will present in sequence. The audience is expected to ask the group members questions about the article and clarifications that require them to defend their position. Powerpoint slides are not required for this activity but may be used if you prefer. Detailed instructions are provided on the course management system. Course evaluations: The MPH Program administers web-based course evaluations to students for each course near the end of the quarter. Your completion of both the unit (course) and faculty evaluation components is required; failure to complete either of the evaluations will result in an incomplete grade until the evaluations 2 P age
are submitted. You will be sent the web link and instructions via email later in the quarter. You will have about two weeks to complete the evaluations before grades are submitted. Academic integrity: Every Northwestern faculty member and student belongs to a community of scholars where academic integrity is a fundamental commitment. The Program in Public Health abides by the standards of academic conduct, procedures, and sanctions as set forth by The Graduate School at Northwestern University. Students and faculty are responsible for knowledge of the information provided by The Graduate School on their Web page at http://www.tgs.northwestern.edu/academics/academicservices/integrity/index.html Academic misconduct includes, but is not limited to 1. Receiving or giving unauthorized aid on examinations or homework 2. Plagiarism 3. Fabrication 4. Falsification or manipulation of academic records 5. Aiding or abetting any of the above The PPH follows The Graduate School s procedure for evaluating alleged academic misconduct, as outlined on the TGS website. http://www.tgs.northwestern.edu/academics/academicservices/integrity/dishonesty/index.html Faculty reserve the right to use the Safe Assignment: Plagiarism Detection Tool that is part of the Course Management System to evaluate student assignments. Information about this tool can be found at http://www.it.northwestern.edu/education/coursemanagement/support/assessments/safeassignment. html Course Evaluation: The Programs in Public Health administer web-based course evaluations to students for each course near the end of the quarter. Your completion of both the unit (course) and faculty evaluation components is required; failure to complete either of the evaluations will result in an incomplete grade until the evaluations are submitted. You will be sent the web link and instructions via email later in the quarter. You will have about two weeks to complete the evaluations before grades are submitted. FINAL GRADES Students are expected to demonstrate mastery of course concepts by participating in class exercises, preparing a final paper and presentation and completing a final examination. The distribution of criteria for grading is provided. Component % Presentation of critical research question 35 Final examination 30 Group debate 15 Targeted class discussions 10 Class participation 10 Letter Grade % A+ 98-100 A 93-97 A- 90-92 B+ 87-89 B 83-86 B- 80-82 C+ 77-79 C 73-76 C- 70-72 F <69 Final grades will be assigned as a weighted percentage of each of the above elements, and letter grades will be assigned as follows. Grades that are not a whole number will be rounded up to the next highest integer: 3 P age
Course Schedule Week 1 Date June 22 June 24 June 29 Introduction to obesity epidemiology Review of course syllabus Assessment of obesity: body composition and anthropometry Obesity Epidemiology: Chapter 1. Introduction to obesity epidemiology and Chapter 5. Body fat and anthropometric measurements Introductions Trends in obesity prevalence by ethnicity, gender and age International trends in obesity Obesity Epidemiology: Chapter 2. Descriptive epidemiology of obesity trends Group activity to describe the sociodemographic correlates of obesity by geographic region. Laptops needed.* Nutrition and obesity Obesity Epidemiology: Chapter 6. Dietary Assessment Methods and Chapter 14. Diet, Nutrition, and Obesity Guest Instructor Week 2 Targeted Class Discussion: Which matters more for weight loss: What you eat or how much you eat? Articles: Article 1/Group 1: Sacks FM. et al. Comparison of weight loss diets with different compositions of fat, protein and carbohydrates. New England Journal of Medicine 2009; 360 (9): 859-873. Article 2/Group 2: Zargaran et al. The effects of 6 isocaloric meals on body weight, lipid profiles, leptin and adiponectin in overweight subjects. International Cardiovascular Research Journal 2014; 8 (2): 52-56. July 1 Physical activity and obesity Obesity epidemiology: Chapter 7. Physical Activity 4 P age
July 6 July 8 Measurement; Chapter 15. Physical, Sedentary Behaviors and Obesity Fetal origins of obesity Obesity epidemiology: Chapter 19. Developmental origins of obesity. Group quiz (not graded but for prizes) on nutrition and obestiy Genetic factors in obesity Research study description: Obesity SNPs: association with BMI before and after bariatric surgery Week 3 July 13 Obesity epidemiology: Chapter 21. Genetic predictors of obesity Genetic Association Studies. Lancet 2005; 366: 1121-1131 Targeted class discussion: Are genes more important than environment for determining food preferences in young children? Group 3: Heritability of food preferences in young children Breen, Plomin and Wardle. Physiology and Behavior 88 (2006): 443-447 Vs. Group 4: Dietary intake of young twins: nature or nurture? Pimpin et al. Am J Clin Nutrition 2013; 98: 1326-34. Class Debate Exercise: Which is more important for weight loss and weight maintenance: physical activity or diet? Week 4 July 15 The written summary of arguments is due to the Course Management System by on July 16 th. Topic: Relationship of obesity with chronic disease development and consequences Obesity epidemiology. Chapters 9: Obesity and Cardiovascular disease and Chapter 10: Obesity and Cancer Targeted class discussion: Is the obesity paradox real? Group 5: Association of All-Cause Mortality with Overweight 5 P age
and Obesity Using Standard Body Mass Index Categories Flegal et al. JAMA 2013; 309: 71-82 and Group 6: Body Mass Index and Mortality among 1.46 Million White Adults. Berrington de Gonzalez et al. NEJM 2010; 363: 2211-9. Week 5 July 20 July 22 July 27 Behavioral interventions to prevent obesity TBD Group activity to design an obesity intervention study Clinical interventions for the prevention and treatment of obesity Padwal et al J Gen Int Med 2011;26:1183-94, Li et al. Ann Intern Med 2005;142:532-546 Evaluating the economics of weight loss: balancing the clinical vs. cost effectiveness of behavioral interventions and clinical interventions loss. *Laptops needed Social and environmental correlates obesity Obesity Epidemiology Chapter 17. Social Determinants of Obesity Kershaw KN et al. Social relationships and longitudinal changes in body mass index and waist circumference: The CARDIA Study. Am J Epidemiology 2014; 179: 567-575. Targeted class discussion: Can changing the neighborhood environment modify obesity? Group 7: Neighborhoods, Obesity and Diabetes: A randomized social experiment. Ludwig J et al. NEJM 2011; 365: 1509 And Week 6 July 29 Group 8: Does Change in the Neighborhood Environment Prevent Obesity in Older Women? Michael YL. Social Science & Medicine 2013; 102: 129-137 No class 6 P age
Week 7 Aug 3 Aug 5 Aug 10 Obesity prevention activities in the City of Chicago TBD Group activity to design a public health intervention in Chicago The economics of obesity Public policy and obesity Hawkes C Global Health 2006;2:4, Ludwig and Pollack JAMA 2009;301:533-535 Group activity to draft an OpEd piece on the economics of obesity. *Laptops needed Final presentations Dr. Arlene Hankinson, Medical Director Chicago Department of Public Health, Chronic Disease and Mental Health Week 8 7 P age