NU 212 Final Paper Assignment, Fall 2004

NU 212 Final Paper Assignment, Fall 2004

College of Nursing and Health Sciences

UNIVERSITY OF MASSACHUSETTS BOSTON

NU 212 Health Promotion and Teaching

Victoria K. Palmer–Erbs, PhD, APRN, BC

NU212 Final Analytic Paper/Writing Assignment 4: Fall 2006

A Simulation Exercise Drawn From Materials From The Writing Proficiency Requirement (WPR) Files Of the University Of Massachusetts Boston

(35% of course grade)

Reading Set Number 1: Weight Cycling

Overview:

In this assignment will be using writing as a method of learning and thinking about how to use a Reading Set of materials to answer a question related to those materials. This assignment is aimed at fine-tuning your critical reading, comprehension, communication and writing skills, and library research skills. This assignment has some similar features to the previous two reading and response papers. These skills will also be of use as you work on the NU 212 Final Analytic Paper Assignment.

This assignment will simulate aspects of the Writing Proficiency Requirement (WPR) experience of the University of Massachusetts Boston. In this assignment, we will be working from official, yet previously distributed Writing Proficiency Exam reading set with focal questions.

You will be reviewing the official Writing Proficiency Evaluation Scoring Rubric focusing on:

• Critical Thinking [Evaluation Area 1 = 40% Critical Thinking]

• Critical Reading [Evaluation Area 2 = 40% Critical Reading] and

• Elements of Writing [Evaluation Area 3 = 20% Elements of Writing].

NU 212 Fall 2004 Assignment- Final Analytic Paper:Final Due Dates:

1. Assignment-- Rough Outline/ self-directed initial Free-Write focusing on your selected question is due-
2. Assignment-- Revised Outline, a more detailed written plan or drawing of a web of connections diagram as a plan for answering the question/writing the paper is due-
3. Assignment-- Final Analytic Paper is due / Wk 10 Wed., Nov. 8, 2006
[Meesh McCarthy and staff meet with us in class tonight to review materials and your work to date.]
Wk 11 Wed., Nov. 15, 2006

Wk 13 Wed., Nov. 29, 2006

VPE writing here—I have reworded this page of WPR questions slightly to conform to the new NU 212 assignment of writing at least a 6 page paper [minimum] as a Final Analytic Paper/ essay. The original Reading Set materials were used when students prepared materials for use in a three-hour examination, which is usual for the WPR Examination experience.

I have left the original dates of the WPR in place. This is the original set of Writing Proficiency Exam Questions for the Readings on Weight Cycling for the Writing Proficiency

Exam given on Monday, June 2, 2003

Set B: Weight Cycling A.M.

Please choose one of the following two questions, to answer in the Final Analytic Paper. The goal of this assignment is to write a response, which answers the question that you have selected. The Final Analytic Paper must be at least six (6) pages in length of writing to answer the question but no longer than 8 pages total. This page length does not include the title page and reference page.

It is essential that you include in your Final Analytic Paper/essay specific references to the articles presented in this Reading Set and that you attribute to the source any material you quote or paraphrase as a citation in the body of the paper. Base your Final Analytic Paper/essay on the information contained in the set of readings, not on your own experience, on outside readings, or on other courses you have taken. Do not search the literature for additional information for writing this paper. Use only the readings provided here to do your work.

Before beginning your analytic paper please read carefully the booklet Nine Elements of Proficiency in Writing, which was distributed in the NU 212 class and is available at the Writing Proficiency Office, in the newly opened Campus Center. (617 287-6330).

Question 1: Write an essay in which you explain Frances Berg’s arguments in “Weight Cycling” about the risks vs. benefits of dieting, the evidence she cites to support her arguments, and the ways in which the other two authors in this set of readings would respond to Berg’s arguments and evidence.

OR

Question 2: You have two friends who are trying to lose some weight. Mary, a 45-year-old school teacher, has been struggling to lose the 15 pounds that she has put on in the last five years. Bill, an 18-year-old wrestling champ from the local high school, has a good shot at making the state playoffs next week if he can drop down from his present weight of 183 pounds to a less challenging weight class of 175 pounds. Using all three readings in this set, advise each friend about the risks and benefits of dieting.

Your paper will be successful if, at its conclusion, you have answered either Question 1 or Question 2 fully and completely. Be sure to follow directions provided in each of the questions.

Your paper will be successful if you:

1) Develop a sustained clear thesis, central idea or hypothesis about the issue throughout the whole paper.

2) Integrate “source” materials [as found in this Reading Set] to support the argument/thesis.

3) Organize the argument in a clear and appropriate sequence of support for the thesis, central idea or hypothesis

4) Identify, Summarize and Define key terms or categories of classification or the problem/question at issue in the reading set.

5) Analyze and Evaluate issues under consideration in the reading set.

6) Synthesize and assess the key assumptions, themes, or ideas in the multiple sources.

7) Present Organized paragraphs both globally and locally

8) Use Sentence level effectiveness and clarity

If so, the reader will have a better understanding of what was written and your evaluation of it.

Before you turn in your exam/NU 212 paper, please make sure that the following information appears in your paper on the cover sheet under the title [not an official part of an APA title, but OK to do this for our purposes]: Reading Set Number 1: Weight Cycling and the question number (#1 or #2) that you are writing about.

For help in writing your paper, please refer to Diana Hacker’s Book or visit the web site

Please see the NU 212 handout Using Hacker’s Book To Write: Notes on Successful Writing Strategies for more ideas on how to approach this.

VPE writing here--

This is the original cover page for the WPR Set of Readings for the

Writing Proficiency Exam, Monday, June 2, 2003

University of Massachusetts Boston

College of Arts and Sciences

Set of Readings for the

Writing Proficiency Exam

Monday, June 2, 2003

at 10 a.m. or 6 p.m. in the Clark Athletic Center, Hockey Rink

Set B: Weight Cycling

All articles have been used by permission of the rights holders; no further copy may be made without their permission. Note: these articles are not written in APA format/style.

You will need to reorganize the information listed in these articles when you write your APA Reference page.

2. The National Task Force on the Prevention and Treatment of Obesity, “Weight Cycling.” Journal of the American Medical Association vol. 272 (October 19, 1994): 1196, 1198-1201.

3. Kelly D. Brownell and Judith Rodin, “The Dieting Maelstrom: Is It Possible and Advisable to Lose Weight?” American Psychologist vol. 49 (September 1994): 781-791. Copyright © 1994 by the American Psychological Association. Adapted with permission. Used by permission of the authors.

First Article

Weight Cycling

by Frances M. Berg

The possible risks of repeated bouts of losing and regaining weight, called weight cycling or yo-yo dieting, have gained wide attention in the public press. And for good reason: if weight cycling is harmful and is the almost inevitable result of weight loss, then perhaps weight loss itself is harmful and weight loss an inappropriate goal even for large patients, placing more importance on prevention.

This possibility has major implications for the $30 to $50 billion weight loss industry and for the focus of health care in the United States.

Weight cycling has been under intense investigation at several institutions in the U.S. and other countries since 1986, following studies that suggested losing weight on a very low calorie diet and regaining that weight made subsequent weight loss more difficult.

However, research has shown inconsistent results on several issues. This has led some researchers to conclude weight cycling is not important. Others believe the variables have not yet been found which affect weight cycling changes -- perhaps certain subgroups are more likely to be affected, or individuals are more vulnerable at times in their lives, such as during pregnancy.

The Diet and Health report of the National Academy of Sciences notes the possible detrimental effects of weight cycling. Similarly, the Surgeon General's Report on Nutrition and Health recommends that "the health consequences of repeated cycles of weight loss and gain" be given "special priority," and a poll of obesity experts lists weight cycling as one of the key causes of obesity.

There is little doubt that weight cycling is extremely prevalent in the U.S. Sixty to 80 million people are trying to lose weight, and most of those who lose weight apparently regain it fairly quickly.

In a review of weight cycling research, Kelly Brownell and Judith Rodin cite a six-year study which tracked the weight of 153 middle-aged adults and found the women lost an average of 27 pounds and gained 31 pounds during the six years. The men lost and gained an average of more than 22 pounds. For the women, this was a gain of 21 percent of their initial body weight, and a loss of 19 percent. For the men it was about 12 percent lost and gained. Another study tracked 332 overweight persons and found the vast majority either lost or gained significant amounts of weight.

Weight cycling research focuses on two major issues:

1. Is weight cycling associated with increased risk to physical or mental health?

2. Does weight cycling make weight management more difficult by invoking survival mechanisms?

Major concerns have been raised that cycles of weight variability increase risk factors and the risk of mortality, especially cardiovascular deaths. Other concerns are that weight cycling may lower metabolic rate, decrease the ability to lose weight, increase the body's fat-to-lean ratio and waist-hip ratio, and increase the appetite for dietary fat.

Cycling May Threaten Heart

Research consistently shows an increase in mortality from all causes and from coronary heart disease with weight cycling.

Weight cycling is associated with greater risks for coronary heart disease and other severe health problems in a major study published recently in the New England Journal of Medicine by L. Lissner and colleagues. The findings are based on a 32-year analysis of weight fluctuations in 3,130 men and women in the Framingham Heart Study.

Individuals with a high weight variability -- many weight changes or large changes -- were 25 to 100 percent more likely to be victims of heart disease and premature death than those whose weight remained stable. They had increased total mortality, and increased mortality and morbidity due to coronary heart disease.

Even though nearly 50 percent of women who diet are not overweight, the researchers note, the weight cycling risks are seen at all weight categories, whether thin or obese.

The degree of weight variability was evaluated in relation to total mortality, mortality from coronary heart disease, morbidity due to coronary heart disease and morbidity due to cancer. Risks were considerably increased for all except cancer, which did not differ significantly. When age groups were considered separately, weight fluctuation was most strongly associated with adverse health outcomes in the youngest group (age 30 to 40). This is also the group seen as most likely to diet.

Researchers from Goteborg, Sweden, and Boston University are involved in the current study. They cite their research in Sweden which found large fluctuations in body weight, measured at three intervals, was associated with heart disease in men and total mortality in both men and women. In an effort to control for weight changes that may have been caused by illness, diseases and deaths for the first four years were excluded. This study does not distinguish between several weight changes and a single large weight change.

The researchers say weight cycling may account for the observed increase in deaths in these ways:

1. Factors that influence coronary risk (such as cholesterol levels) may change with fluctuating weight and end up worse than before.

2. During weight loss, a person loses both fat and lean body mass, but may regain mostly fat. This fat tends to settle in the abdomen, a location linked to increased heart disease risk.

3. People may increasingly prefer high fat diets when they lose and regain weight. Studies have shown that weight-cycling laboratory animals tend to eat more fat.

Their findings suggest it may be important to look at public health implications of current weight loss practices. They note that about half of American women and one-fourth of men are dieting at any one time, with many of these efforts unsuccessful. Weight is commonly regained and the cycle repeated.

Kelly Brownell, PhD, a psychologist and weight specialist at Yale University involved in the study, says the harmful effects of weight cycling may be equal to the risks of remaining obese. "The pressure in this society to be thin at all costs may be exacting a serious toll," Brownell says. The study's findings indicate that weight cycling is "potentially a very serious public health issue" because it affects such large numbers of people. "It may be equally bad to lose the same five pounds 10 times as to lose 50 pounds and regain it once," he said.

Harvard Alums Risk Disease by “Always" Dieting

Men risk heart disease, hypertension and diabetes by 'always' dieting, regardless of their weight, according to the Harvard Alumni studies reported by Steven N. Blair, an epidemiologist at the Cooper Institute for Aerobics Research in Dallas. "One of the fundamental tenets of the weight loss industry is if you get people to eat less, they'll lose weight. And if they lose weight, they'll be better off. And there is no evidence to support either one," Blair said at the American Heart Association's annual epidemiology meeting in March 1994.

Earlier, Blair reported higher mortality with weight loss among the Harvard alumni. His latest report investigates non-fatal disease in 12,025 men, average age 67. The men who said they were always dieting had a heart disease rate of 23.2 percent, compared to 10.6 for those who "never" dieted. Their rates for hypertension were 38.3 percent, compared with 23.4 percent for the group who never dieted, and for diabetes 14.6 percent, compared with 3 percent. Among men who dieted part of the time -- "often," "sometimes," or "rarely" -- the more they dieted, the higher their rates of disease. These findings held true even among the leanest group of men, and were basically unchanged by weight gain, physical activity, smoking or alcohol intake.

In addition to reporting dieting frequency, the men identified their shape variation at six points through life, total pounds lost, and the number of times they had lost 5, 10, 20 and 30 or more pounds. In view of his findings, Blair advises people to keep a stable weight and avoid either weight gain or weight loss.

Bone Loss with Weight Loss

Several studies of large population bases show higher mortality rates with weight loss, causing researchers to puzzle over the possible mechanisms whereby weight loss could cause long-term harm, even though it seems beneficial in reducing obesity-related risk factors in short term studies.

One possible mechanism may be the bone mineral loss which accompanies weight loss. Weight cycling may increase this loss.

Mineral content in women's bones diminishes with weight loss, even when adequate nutrition and aerobic exercise are present. These findings from the USDA Human Research Center in Grand Forks, N.D., support clues which may explain recent findings in federal studies of potentially higher mortality with weight loss. The Grand Forks Center tested 14 women, age 21-38, in a five month residential program using dual energy x-ray absorptiometry (DXA) to assess bone mineral status and soft tissue composition. The women lost 8.1 kg on a moderate nutrient-adequate diet with an aerobic exercise program. Both bone mineral content and bone mineral density decreased.

Similar results were found at the Osteoporosis Research Centre in Copenhagen, Denmark. Using the DXA method, the study reports 51 obese patients averaged a 5.9 percent loss of total body bone mineral/TBBM during 15 weeks. One patient, who lost 45 kg, lost 754 g bone mineral in nine months. Greater mineral loss was reported in legs than arms. Post- menopausal women who did not get estrogen replacement tended to lose more bone mineral. Bone mineral loss correlated with body fat loss, not with fat-free mass loss, so that as more fat was lost, more mineral was lost as well.