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Alyssa L. West HHE 467 Melanie Tucker 11, April 2014 Implementing a Health Program on Students of The University of Alabama that are Overweight or Obese Low-Fat Dieters that Encounter Frequent Binge Eating Episodes

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Introduction Healthy is a term broad in its meaning. It can be used to describe the absence of disease, having an active lifestyle, having eating habits that are considered clean, and many other definitions. The definition of healthy in relation to a nutritious diet would be the balance of nutrients to enhance everyday performance, weight maintenance, satisfaction and satiety from the foods consumed, and happiness at the end of the day from a strong mind and satisfied body. In Healthy People 2020, the American diet goal is stated as: promoting healthful diets and healthy weight encompasses increasing household food security and eliminating hunger. With our society demonizing the intake of fats for the last generation, Americans do not realize the importance fats are in the functioning of their body and mind, as well as prevention of hunger. This intervention will target college student dieters at The University of Alabama attempting to restrict their fat intake to little or none a day, or so they attempt, but failing by uncontrollable food binges. Health Problem The obesity epidemic among ages 18 and older has tripled since the early 1970s (National Center for Health Statistics, 2008). Through statistics provided by the Weight-control Information Network (2010), shown in table 1, a rise in the percentage of Americans overweight and obese correlates with the same year that the Dietary Guidelines for Americans of 1980 took over the nutrition labels and recommendations everywhere. According to data from Nutrition Monitoring for the United States (U.S. Department of Health and Human Services, 1986), before 1980 dietary fat intake averaged 41% of total calorie consumption, after the newest dietary guidelines were published, recommendations for high-fat diets were to not exceed 35% and for

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low-fat diets less than 20% (U.S. Department of Health and Human Services, 2005). The Dietary Guidelines of 1980 suggests that to lose weight one should limit their fat intake, yet since then obesity has skyrocketed. Due to the new scare of fats the Dietary Guidelines for Americans has influenced, the importance of this nutrient has been forgotten. The Dietary Guidelines for Americans suggesting fat as the reason for weight gain has shaped how nutritionists encourage diets with low-fat options to reduce total calorie consumption, such as in Symposium on Obesity: genes, drugs and dietary treatment, where a diet low in energy and fat is promoted for obesity weight loss (Moloney, 2000). It is well known that to lose weight there must be an energy deficit from the calories consumed and calories burned, but according to a study comparing high-fat and low-fat diets, it is the quality of the fat-containing food intake that is the foundation of a healthy body and weight loss regime (Blaisdell, Lau, Telminova, Lim, Fan, Fast, Garlick, & Pendergrass, 2014). Therefore, simply eating low-fat alternatives is not the key to weight loss. When foods that were originally a source of dietary fats have been altered, they result in being sources of unnecessary carbs and unnatural sugar. Researchers are now finding within this issue that Americans who are depriving their body of essential nutrients from dietary fats have increased their levels of stress, depression, and binge eating and ultimately, weight gain (Finger, Dinan, & Cryan, 2011) (Gormally, Black, Daston, & Rardin, 1982) (Holford, 2003) (Fairburn, 1995).

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Trends in Overweight and Obesity among Adults, United States, 19622010** Overweight Obesity Extreme obesity

Table 1 A benefit of incorporating the appropriate amount of essential fats in ones diet is the enhancement of mood, which, in return, lowers the rate of a persons state of depression and stress. A chemical strongly found in omega-3 fatty acids is eicosapentaenoic acid (EPA), which has been scientifically proven to influence the mood effecting part of the brain (Kidd, 2007). In a study on the components of essential fatty acids by Holford (2003), omega-3 fats have a direct influence on serotonin levels, a major stimulus on mood. Along with fatty acids improving mood, they also have been shown to have a positive effect on decreasing stress. Another study provided evidence that high-fat diet protects from stress-induced changes in symptoms of general anxiety and depression (Finger et. al, 2011). Researchers have also discovered that people with a higher long-chain omega-3 fat diet showed to be satiated longer and less likely to be hungry after dinner (Parra, Ramel, Bandarra, Kiely, Martinez, & Thorsdottir, 2008). The trend found in depriving your body from any essential nutrient results in a craving so severe that by the end of the day most are unable to control the cravings and engage in a binge eating episode

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followed by the feeling of guilt (Fairburn, 1995). This health problem is a constant battle because after the binge eating and harsh feelings towards ones self, the cycle repeats day after day in attempt to become more disciplined, only to continue to fail and seeing the number on the scale rise. The health program being implemented roots from the belief that by incorporating the right amount of essential fats in ones diet to enhance mood and satiety, students at The University of Alabama will see a change in contentment at the end of the day, thus lowering the risk of being defeated by a too high standard of a diet and the inability to control binge eating episodes. By lowering the frequency of binge eating, students will have a less difficult time losing or inability to maintain their weight. According to the data collected from The University of Alabama undergraduate and graduate students, 40% of the surveyed had a BMI that considered them to be overweight or obese. In comparison, the nation percentages of overweight or obesity among adults age 20 years and older are currently 68.8% (NHANES, 2009-2010). Out of the university students, 50% claimed to be trying to lose weight and 42% expressed dieting as a means to drop the unwelcome pounds. When asked if the students wanted information on nutrition, almost 50% stated they did even when over half of the students surveyed claimed they had already been given information on the subject. Perhaps students are requesting more information due to the material they have either was not applicable for their life style, or the information given is so advanced that following the diet gives the students a low self-efficacy in their perceived ability to succeed. Either way, updated information needs to be given that educates the students on the benefits of a balanced diet that includes essential fats to prevent the cravings and stay full throughout their strenuous day. Binge Eating as a Modifiable Risk Factor

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By the students balancing their everyday diet and consuming the right amounts of fats that control hunger and cravings, binge eating later in the day becomes a modifiable risk factor. Through these studies we see that the high standards of control over excluding certain foods from ones diet results in depressed feelings of not being able to succeed in such a controlling diet and ultimately creating a continuous cycle of binge eating. Students at The University of Alabama are constantly busy with school work and classes, already putting a stress on their wellbeing. With the added pressure to be at a slim weight and the popular diets of cutting out fats, they are constantly being defeated from their goals. In a study on binge eating severity among obese persons, researchers found that unrealistic expectations and low-self efficacy towards their perceived ability to maintain their diet were prominent cues to a binge (Gormally et. al, 1982). It is also suggested that binging is an outcome of deprivation and excessively high-standards for dieting. Dieting is hard because people associate it with eliminating the foods they enjoy, when in fact it is the nutrients in essential foods that the body craves. In a binge eating intervention questionnaire study, one the subjects of Hawkins and Clement (1980) exclaimed that she would begin her day saying Today will be a perfect dieting day. Just by proclaiming this she set herself up to fail, and did so many times. If students are taught to choose a balanced diet that incorporates all essential nutrients including healthy fats and develop it into a lifestyle, they would greatly lower their risk of low self-efficacy towards their daily diet. Resulting in reducing cravings for highly processed foods or hydrogenated trans fats and increase chances of being satisfied throughout the day with how they feel physically and emotionally. These steps in creating a lifestyle change and a new view of a healthy and balanced diet would aid in binge eating as a modifiable risk factor. Proposed Solution

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Educating on lifestyle change by incorporating essential fatty acid containing foods among students at The University of Alabama would improve their self-efficacy towards their diet and prevent hunger and binge eating from lack of this crucial nutrient. The proposed project will use the Health Belief Model (Hochbaum & Rosenstock, 1985) to guide the development of the intervention. The first step to solving the health issue of binge eating from a deficiency in essential fats is by performing a health education class for the students in search for a change on how to lose weight and end their uncontrollable binges. For a higher rate of attendance, the health education class will meet in the Ferguson Center third floor computer lab at 6 oclock in the afternoon, when parking is available to anyone. The program will emphasize on retraining the students on their perception of fat, followed by teaching them how to incorporate the right amount into their daily calorie needs in respect to their weight loss goals. The perceived benefit of this program will show The University of Alabama students that their levels of mood will be enhanced, that their hunger and cravings between meals be decreased, and their risk of binge eating due to lack of essential nutrients reduced. The combination of these effects of raising fat consumption will ultimately provide students with their goal of losing weight and maintaining the loss by creating a lifestyle change, rather than a temporary diet. A study conducted by separating rats into two groups, one on a high fat diet and the other on a low fat diet, showed that being on a low fat food diet left the animals feeling less energized and the inability to perform normally (Blaisdell et. al, 2014). Bodies that are deprived of essential fatty acids that effect mood, hunger levels, and satiety affect the level of energy and motivation one has. Therefore, not only would a lifestyle change among the students help their weight but also their performance in school and exercise.

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Another study that will be used in providing the students with education on weight loss nutrition was conducted on 132 severely obese men and women. It was discovered that reducing carb consumption had a higher rate of weight loss over lowering fat (Samaha, Iqbal, Seshari, Chicano, Daily, McGrory, Williams, Williams, Gracely, & Stern, 2003). The reasoning behind these results is said to be because with a low carb/higher fat consumption the outcome was more satiety from meals and the low fat/high carb diet resulted in a higher caloric intake because of their being an unsatisfied hunger level. To understand more behind the amount of each macronutrient that is needed for overall health each day, students can use online resources to calculate their Resting Metabolic Rate (RMR), followed by the grams of each macronutrient (carbohydrates, protein, and fat) per pound of body fat that their body needs, as well as daily calorie consumption that correlates with their weight loss or maintaining goals. Alignment of Program Benefits to Values of Decision Makers A program to implement lifestyle change through adopting a higher percentage of dietary essential fats in students everyday diet will examine how the dietary guidelines had the wrong suggestions back in 1980 that sent the obesity epidemic on a downward spiral. This study will be used in the health education course for The University of Alabama students to improve their dietary habits and reduce their binge eating episodes. Twelve student volunteers from The University of Alabama under the overweight and/or obese criteria that engage in binge eating episodes at least three times a week at the end of a good dieting day will be needed to investigate this six week study. A new diet for each of the volunteers body consumption needs will be developed and provided in detail through calculating the macronutrient (carbohydrates, protein, and dietary fat) in grams per pound of body weight. They will begin the program by attending a meeting the morning of the first day, educating them on the essentials of the nutrient

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fat and learning how by adding more dietary fat they will decrease their binge eating episodes and gain control over their weight gain. The volunteers will then be measured at the waist and hips by tape measure and weighed on a calibrated scale to document progress. A questionnaire will be implemented on their current dieting habits and how they feel at the end of the day as well as how often they engage in binges. There will be three check-ups, one every two weeks, for formative evaluations. At each evaluation during the program, the participants will answer a questionnaire on their progress or setbacks as well as be re-measured and weighed. At the end of the six week program, participants will have a summative evaluation through the results in a final questionnaire and analysis on their waist and hip circumference and body weight. Conclusion Essential dietary fats are an important role in the human body, playing a part in mood and hunger prevention. By enhancing mood, and therefore lowering depression, and increasing between meal satiety, students who are attempting to lose weight will experience elevated motivation and control over binge eating episodes. Students should begin to see improvement from incorporating essential fats in meals through their physical and emotional performance. It is through a balanced diet that the body can perform to its fullest capabilities. By providing the mind and body with what it is actually craving, the student beginning this lifestyle change will show more control in resisting foods that bring the body down. By the data that has been collected it is becoming more knowledgeable that dieting has gone wrong the last generation and perhaps the students at The University of Alabama can be the turning point in showing how simple lifestyle changes and education on essential nutrients can reverse the rise in obesity to finally decrease among college students and through time all of America.

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References Blaisdell, A. P., Lau, Y. L. M., Telminova, E., Lim, H. C., Fan, B., Fast, C. D., Garlick, D., and Pendergrass, D. C. (2014). Food quality and motivation: A refined low-fat diet induces obesity and impairs performance on a progressive ratio schedule of instrumental lever pressing in rats. Physiology & Behavior, 128, 220-225. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009-2010, Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.pdf Fairburn, C. G. (1995). Overcoming Binge Eating. New York, NY: The Guilford Press. Finger, B. C., Dinan, T. G., and Cryan, J. F. (2011). High-fat diet selectively protects against the effects of chronic social stress in the mouse. Neuroscience, 192, 351-360. Gormally, J., Black, S., Daston, S., and Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7(1), 47-55. Hawkins II, R. C., and Clement, P. F. (1980). Development and construct validation of a selfreport measure of binge eating tendencies. Addictive Behaviors, 5(3), 219-226. Holford, P. (2003). Depression: The nutrition connection. Primary Care Mental Health, 1, 9-16. Kidd, P. M. (2007). Omega-3 DHA and EPA for cognition, behavior, and mood: Clinical findings and structural-functional synergies with cell membrane phospholipids. Alternative Medicine Review, 12(3), 207-227.

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Moloney, M. (2000). Symposium on obesity: genes, drugs, and dietary treatment. Proceedings of the Nutrition Society, 59(4), 601-608. Parra, D., Ramel, A., Bandarra, N., Kiely, M., Martinez, J. A., and Thorsdottir, I. (2008) A diet rich in long chain omega-3 fatty acids modulates satiety in overweight and obese volunteers during weight loss. Appetite, 51(3), 676-680. Samaha, F. F., Iqbal, N. M.D., Seshari, P. M.D., Chicano, K. L. Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J., and Stern, L. (2003). A low-carbohydrate as compared with a low-fat diet in severe obesity. The New England Journal of Medicine, 348, 2074-2081. Table 1. U.S. Department of Health and Human Services. (2012). Overweight and obesity statistics. Weight-Controll Information Network. [Trends in overweight and obesity among adults, united states, 1662-2010] Retrieved from http://win.niddk.nih.gov/publications/PDFs/stat904z.pdf U.S. Department of Health and Human Services. (1980). Nutrition and Your Health: Dietary Guidelines for Americans. Retrieved from http://www.health.gov/dietaryguidelines/1980thin.pdf U.S. Department of Health and Human Services. (1986). Nutrition Monitoring in the United States: A progress Report from the Joint Nutrition Monitoring Evaluation Committee. Retrieved from http://www.cdc.gov/nchs/data/misc/nutri86acc.pdf

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U.S. Department of Health and Human Services. (2005). Dietary Guidelines for Americans 2005. Retrieved from http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf U.S. Department of Health and Human Services, (2008). Health, Unites States, 2008 with Special Feature on the Health of Young Adults. Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf U.S. Department of Health and Human Services. (2012). Overweight and obesity statistics. Weight-Controll Information Network. Retrieved from http://win.niddk.nih.gov/publications/PDFs/stat904z.pdf