This dissertation provides an ethical justification of surgical weight loss interventions for the treatment of obesity. Situating obesity as not merely a public health concern but also fundamentally a problem of clinical medicine confronting individual patients and physicians, the dissertation argues that the time frame of public health interventions is too long for individuals presently facing obesity and its deleterious physical and social co-morbidities. It argues that failure to address weight loss on an individual level, and specifically to consider the clinical appropriateness of weight loss surgery (WLS), raises serious questions about failure to respect autonomy and promote patient welfare. Moreover, social skepticism or rejection of WLS as a treatment option raises concerns about fairness, as this failure indicates that obesity is not regarded in relevantly similar ways to other life-threatening and health-impairing conditions. The dissertation examines various reasons that obesity and its myriad interventions, including WLS, are inadequately addressed in the clinical setting. It argues that considerations with cultural and ethical valence play a critical role in obesity's different and unfair treatment within clinical medicine. Gendered and theologically informed attributions of blame, self-blame, shame, and self-stigma influence the attitudes and actions of both patients and clinicians with regard to addressing obesity. Inappropriate and conceptually confused ascriptions of responsibility impede social acceptance of, and access to, WLS. The dissertation's criticism and subsequent reconceptualization of these ascriptions of responsibility from a perspective informed by feminist epistemology and ethics provide the foundation upon which to consider reform of current clinical practices surrounding treatment of obesity. This dissertation concludes that WLS is both ethically and clinically justified. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Canadian statistics indicate that the incidence of obesity is rising, and that the prevalence of type 2 diabetes mellitus (T2DM) within this group is significantly higher than those of a healthy weight. Preliminary evidence has shown that the oil-rich grain, Salvia hispanica L. (Salba), improves glycemic control, suppresses appetite, and affects additional cardiovascular disease (CVD) risk factors. This study followed a randomized, double-blind, placebo-controlled, parallel design in a sub-set population of twenty individuals who were overweight or obese and had T2DM. Participants received supplements of Salba, or an energy- and fibre-matched control, and followed a hypocaloric diet for 24 weeks. Findings of this study reveal that Salba does not significantly affect weight loss, glycemic control or other CVD risk factors. These findings are preliminary and highlight the complexities of weight loss research. Further investigation into the potential health benefits of Salba is currently being carried out.

Canadian statistics indicate that the incidence of obesity is rising, and that the prevalence of type 2 diabetes mellitus (T2DM) within this group is significantly higher than those of a healthy weight. Preliminary evidence has shown that the oil-rich grain, Salvia hispanica L. (Salba), improves glycemic control, suppresses appetite, and affects additional cardiovascular disease (CVD) risk factors. This study followed a randomized, double-blind, placebo-controlled, parallel design in a sub-set population of twenty individuals who were overweight or obese and had T2DM. Participants received supplements of Salba, or an energy- and fibre-matched control, and followed a hypocaloric diet for 24 weeks. Findings of this study reveal that Salba does not significantly affect weight loss, glycemic control or other CVD risk factors. These findings are preliminary and highlight the complexities of weight loss research. Further investigation into the potential health benefits of Salba is currently being carried out.

The purpose of this study was to determine the effects of following either the Curves® Fitness and Weight Management Plan or the Weight Watchers® Momentum™ Plan on body composition and markers of health and fitness in previously sedentary obese women. Fifty-one women (age 35±8 yrs; height 163±7 cm; weight 90±1 kg; BMI 34±5 kg/m2; 47±7% body fat) were randomized to participate in the Curves® (C) or Weight Watchers® (W) weight loss programs for 16-wks. Participants in the C group (n=24) followed a 1,200 kcal/d diet for 1-wk; 1,500 kcal/d diet for 3 wks (~30%:45% CHO:PRO); and 2,000 kcals/d for 2-wks (45:30) and repeated this diet while participating in a supervised Curves® with Zumba program 3-d-wk. Remaining subjects (n=27) followed the W point-based diet program, received weekly group counseling, and were encouraged to exercise. Body composition, anthropometrics, resting energy expenditure (REE), lipid biomarkers, and hormone concentrations were assessed at 0, 4, 10, and 16 weeks. Maximal cardiopulmonary exercise capacity and upper and lower body isotonic strength and endurance were assessed at 0 and 16 weeks. Data were analyzed using multivariate analysis of variance for repeated measures. MANOVA analysis of body composition data revealed overall time (Wilks’ Lamda p=0.001) and time by diet effects (Wilks’ Lamda p=0.003). Subjects in both groups lost a similar amount of total mass (C -2.4±2.0, -4.1±3.4, -5.1±3.9; W -2.3±2.3, -4.5±3.0, -5.5±4.6 kg, p=0.78). However, subjects in the C group tended to have a greater reduction in percent body fat (C -3.3±5.2, -3.2±4.6, -4.7±5.4; W 0.6±6.7, -0.6±8.3, -1.4±8.1%, p=0.10) and body fat mass (C -3.9±5.5, -4.6±5.3, -6.4±5.9; W -0.4±5.7, -2.1±6.7, -2.9±7.8 kg, p=0.09), while maintaining FFM (C 1.5±4.3, 0.52±3.7, 1.3±4.0; W -1.8±5.4, -2.4±5.8, -2.5±5.1, p=0.01). While both groups had increases cardiovascular fitness, the C group experienced improvements in upper body muscular endurance (C 1.4±3.9; W -1.2±2.4 repetitions, p=0.006). Both groups experienced improvements in lipid biomarkers; however, only the C group experienced a moderate increase in HDL-c. Results indicate that participants following the C program experienced more favorable changes in body composition and markers of fitness and health than participants in the W program.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

This pilot study assessed the feasibility, acceptability and efficacy of a novel approach to facilitating dietary change and weight loss in obese adults by presenting vegan environmental, health and farm animal treatment information in a 6 week, group-based, educational nutrition program (called a vegan healthy eating program). Twenty-nine (29) medically stable, obese adults were recruited from 3 ambulatory care clinics at UCSF and enrolled using partial randomization into one of two serially occurring intervention groups (Group 1 n=14, followed by Group 2 n=15). A delayed intervention control group (n=9) was used, consisting of participants enrolled in Group 2 who were available for collection of baseline measures prior to the start of Group 1s intervention. All intervention participants provided data immediately following their vegan healthy eating program (2 months post baseline) and again at 3 and 9 months post baseline. 10% of initial contacts (29 patients) met inclusion and exclusion criteria and were enrolled; 25 participants were retained at 3 months, 20 at 9 months. Mean intervention session satisfaction as measured by anonymous surveys using a 1-7 Likert scale (1=extremely unsatisfied, 7=extremely satisfied) was 6.2 (SD=1.1). Statistically significant reductions in calories from animal products, percent fat, cholesterol and increases in the recommended food score, fruits and vegetable servings were observed within the intervention group only, at all timepoints. Mean weight change was +2.8 lbs (3.0, n=8, p=0.035) in control participants after 4.3 weeks, and -3.4 lbs (5.0, n=25, p=0.002), -5.9 lbs (7.7, n=25, p=0.001), and -8.8 lbs (14.2, n=20, p=0.012) after 7.3, 15.6 and 41.7 weeks in intervention participants, respectively. In conclusion, this vegan healthy eating program demonstrated good feasibility, high satisfaction, and facilitated a shift towards a plant-based diet and modest, progressive short-term weight loss among intervention participants.

Thesis (M.A.)--University of Central Florida, 2009. / Adviser: Jonathan Matusitz. Includes bibliographical references (p. 91-101).

Thesis (Ph. D.)--Oregon State University, 2010. / Printout. Includes bibliographical references (leaves 76-78). Also available on the World Wide Web.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice