Criminal History Policy and Acknowledgement
Upon successful completion of this course students will be able to sit for national certification in first aid and CPR. Directed field experience may be required. National Center for Complementary and Alternative Medicine. Admission into the major as part of a cohort group occurs in the Fall Semester. Emphasis is placed on acute responses and chronic adaptations of the musculoskeletal and cardiorespiratory systems to physical activity. Skills in administering graded exercise testing with ECG monitoring, pulmonary function testing, and screening for metabolic disease will be emphasized in laboratory settings. Emphasis on critical thinking and translation of nutritional knowledge to real-world settings.
Results from a clinical trial that enrolled patients without diabetes showed that patients had an average weight loss of 4. In this trial, 62 percent of patients treated with liraglutide lost at least 5 percent of their body weight compared with 34 percent of patients treated with placebo. Results from another clinical trial that enrolled patients with type 2 diabetes showed that patients had an average weight loss of 3. In this trial, 49 percent of patients treated with liraglutide lost at least 5 percent of their body weight compared with 16 percent of patients treated with placebo.
The FDA approved labeling states that patients using liraglutide should be evaluated after 16 weeks to determine if the treatment is working FDA, If a patient has not lost at least 4 percent of baseline body weight, liraglutide should be discontinued, as it is unlikely that the patient will achieve and sustain clinically meaningful weight loss with continued treatment.
Saxenda is a glucagon-like peptide-1 GLP-1 receptor agonist and should not be used in combination with any other drug belonging to this class, including Victoza, a treatment for type 2 diabetes FDA, Saxenda and Victoza contain the same active ingredient liraglutide at different doses 3 mg and 1. However, Saxenda is not indicated for the treatment of type 2 diabetes, as the safety and efficacy of Saxenda for the treatment of diabetes has not been established.
Saxenda has a boxed warning stating that thyroid C-cell tumors have been observed in rodent studies with liraglutide but that it is unknown whether liraglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma MTC , in humans FDA, Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether liraglutide causes thyroid C-cell tumors, including MTC, in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined.
The labeling states that liraglutide is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2 MEN 2 FDA, The labeling states that patients should be counseled regarding the risk of MTC with use of liraglutide and informed of symptoms of thyroid tumors e.
The labeling states that routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with liraglutide. Serious side effects reported in patients treated with liraglutide for chronic weight management include pancreatitis, gallbladder disease, renal impairment, and suicidal thoughts FDA, Liraglutide can also increase heart rate and should be discontinued in patients who experience a sustained increase in resting heart rate.
Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with liraglutide Novo Nordisk, After initiation of liraglutide, patients should be observed for signs and symptoms of pancreatitis including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting.
If pancreatitis is suspected, liraglutide should promptly be discontinued and appropriate management should be initiated. If pancreatitis is confirmed, liraglutide should not be restarted.
Substantial or rapid weight loss can increase the risk of cholelithiasis; however, the incidence of acute gallbladder disease was greater in liraglutide-treated patients than in placebo-treated patients even after accounting for the degree of weight loss Novo Nordisk, If cholelithiasis is suspected, gallbladder studies and appropriate clinical follow-up are indicated.
When liraglutide is used with an insulin secretagogue e. The labeling recommends lowering the dose of the insulin secretagogue to reduce the risk of hypoglycemia. Renal impairment has been reported postmarketing, usually in association with nausea, vomiting, diarrhea, or dehydration, which may sometimes require hemodialysis Novo Nordisk, The labeling recommends using caution when initiating or escalating doses of liraglutide in patients with renal impairment.
Serious hypersensitivity reactions e. The labeling recommends that patients stop taking liraglutide and seek medical advice if symptoms of hypersensitivity reactions occur. Liraglutide should be discontinued in patients who experience suicidal thoughts or behaviors. Liraglutide should be avoided in patients with a history of suicidal attempts or active suicidal ideation. The labeling states that nursing mothers should either discontinue liraglutide for chronic weight management or discontinue nursing Novo Nordisk, The labeling states that the safety and effectiveness of liraglutide have not been established in pediatric patients and is not recommended for use in pediatric patients.
In addition, the cardiovascular safety of liraglutide is being investigated in an ongoing cardiovascular outcomes trial. Lingwood stated that there is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis BIA meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends.
These researchers reviewed the literature regarding the use of bioelectrical impedance in neonates. It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts.
Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates. The authors concluded that further research is needed into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realize the full potential of this technology. These investigators reviewed available information on the short- and long-term effects of intervention treatment on body fat composition of overweight and obese children and adolescents and, to obtain a further understanding on how different body composition techniques detect longitudinal changes.
A total of 13 papers were included; 7 included a multi-disciplinary intervention component, 5 applied a combined dietary and physical activity intervention and 1 a physical activity intervention. Body composition techniques used included anthropometric indices, BIA, and dual energy X-ray absorptiometry.
Percentage of fat mass change was calculated in when possible. Findings suggested, no changes were observed in fat free mass after 16 weeks of nutritional intervention and the lowest decrease on fat mass percentage was obtained.
However, the highest fat mass percentage with parallel increase in fat free mass, both assessed by DXA was observed in a multi-component intervention applied for 20 weeks. The authors concluded that more studies are needed to determine the best field body composition method to monitor changes during overweight treatment in children and adolescents. Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies.
These investigators performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. They included 50 published studies. Mean differences between BIA and reference methods gold standard [criterion validity] and convergent measures of body composition [convergent validity] were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity.
These investigators found strong evidence for a good reliability, i. However, test-retest mean differences ranged from 7. However, they stated that validity and measurement error were not satisfactory. Goldberg et al stated that the sensory and gastro-intestinal changes that occur with aging affect older adults' food and liquid intake.
Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of BIA to measure hydration in 19 older women in residential care: The authors concluded that if results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.
Buffa et al defined the effectiveness of bioelectrical impedance vector analysis BIVA for assessing 2-compartment body composition. Selection criteria included studies comparing the results of BIVA with those of other techniques, and studies analyzing bioelectrical vectors of obese, athletic, cachectic and lean individuals. A total of 30 articles met the inclusion criteria.
The ability of classic BIVA for assessing 2-compartment body composition has been mainly evaluated by means of indirect techniques, such as anthropometry and BIA. Classic BIVA showed a high agreement with body mass index, which can be interpreted in relation to the greater body mass of obese and athletic individuals, whereas the comparison with BIA showed less consistent results, especially in diseased individuals.
The authors concluded that specific BIVA is a promising alternative to classic BIVA for assessing 2-compartment body composition, with potential application in nutritional, sport and geriatric medicine. Haverkort et al noted that BIA is a commonly used method for the evaluation of body composition. However, BIA estimations are subject to uncertainties. These researchers explored the variability of empirical prediction equations used in BIA estimations and evaluated the validity of BIA estimations in adult surgical and oncological patients.
Studies developing new empirical prediction equations and studies evaluating the validity of BIA estimations compared with a reference method were included.
Only studies using BIA devices measuring the entire body were included. Studies that included patients with altered body composition or a disturbed fluid balance and studies written in languages other than English were excluded. To illustrate variability between equations, fixed normal reference values of resistance values were entered into the existing empirical prediction equations of the included studies and the results were plotted in figures.
Estimates of the FM demonstrated large variability range relative difference The authors concluded that application of equations validated in healthy subjects to predict body composition performs less well in oncologic and surgical patients. They suggested that BIA estimations, irrespective of the device, can only be useful when performed longitudinally and under the same standard conditions.
Gibson et al stated that VLEDs and ketogenic low-carbohydrate diets KLCDs are 2 dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent.
To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, these researchers conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analog scales VAS before in energy balance and during while in ketosis adherence to VLED or KLCD.
Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry or more full or satisfied.
Ketosis appears to provide a plausible explanation for this suppression of appetite. The authors concluded that future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet. Bueno and colleagues examined the effect of replacing dietary long-chain triacylglycerols LCTs with medium-chain triacylglycerols MCTs on body composition in adults.
These researchers conducted a meta-analysis of RCTs, to examine if individuals assigned to replace at least 5 g of dietary LCTs with MCTs for a minimum of 4 weeks show positive modifications on body composition. Two authors independently extracted data and assessed risk of bias. Weighted mean differences WMDs were calculated for net changes in the outcomes.
These investigators assessed heterogeneity by the Cochran Q test and I 2 statistic and publication bias with the Egger's test. Pre-specified sensitivity analyses were performed.
A total of 11 trials were included, from which 5 presented low risk of bias. The overall quality of the evidence was low-to-moderate. Trials with a cross-over design were responsible for the heterogeneity. The authors concluded that despite statistically significant results, the recommendation to replace dietary LCTs with MCTs must be cautiously taken, because the available evidence is not of the highest quality.
Changes in blood lipid levels were secondary outcomes. Identified trials were assessed for bias. Mean differences were pooled and analyzed using inverse variance models with fixed effects. Heterogeneity between studies was calculated using I 2 statistic. No differences were seen in blood lipid levels.
Many trials lacked sufficient information for a complete quality assessment, and commercial bias was detected. Although heterogeneity was absent, study designs varied with regard to duration, dose, and control of energy intake.
The authors concluded that replacement of LCTs with MCTs in the diet could potentially induce modest reductions in body weight and composition without adversely affecting lipid profiles.
However, they stated that further research is needed by independent research groups using large, well-designed studies to confirm the effectiveness of MCT and to determine the dosage needed for the management of a healthy body weight and composition.
They performed a search of English-language articles in the PubMed and Embase databases through April 30, Differences in weight loss between FTO genotypes across studies were pooled with the use of fixed-effect models. A meta-analysis of 10 studies comprising 6, participants that reported the results of additive genetic models showed that individuals with the FTO TA genotype and AA genotype those with the obesity-predisposing A allele had 0.
A meta-analysis of 14 studies comprising 7, participants that reported the results of dominant genetic models indicated a 0. In addition, differences in weight loss between the AA genotype and TT genotype were significant in studies with a diet intervention only, adjustment for baseline BMI or body weight, and several other subgroups.
However, the relatively small number of studies limited these stratified analyses, and there was no statistically significant difference between subgroups. Hypoxic conditioning has been previously used by healthy and athletic populations to enhance their physical capacity and improve performance in the lead up to competition. Recently, HC has also been applied acutely single exposure and chronically repeated exposure over several weeks to over-weight and obese populations with the intention of managing and potentially increasing cardio-metabolic health and weight loss.
At present, it is unclear what the cardio-metabolic health and weight loss responses of obese populations are in response to passive and active HC.
Exploration of potential benefits of exposure to both passive and active HC may provide pivotal findings for improving health and well-being in these individuals.
These researchers carried out a systematic literature search for articles published between and Click here to see Denise Richards describe how she loves that she does not have to put strain on her lower back with The Flex Belt. Click here To Watch a video about why Dr. Porcari chooses The Flex Belt as his top pick in this category. Flex Belt is as convenient as it is innovative.
Simply wearing the belt provides consumers with the benefits of years of research. The medical-grade technology behind The Flex Belt stimulates abdominal muscles, all on it's own. The Flex Belt manufacturer is a medical device company based in Ireland. The company has 40 years of experience with EMS technology and their devices have been used in 5, clinics across the globe. These 40 years of experience have led to an ergonomically engineered device that works the muscles of the entire abdominal area.
Yes, that means your upper abs, the lower abs and even your obliques are going to get worked from The Flex Belt. The company is extremely confident in its product, and so Flex Belt comes with a day money back guarantee. The Flex Belt should be used once a day, five days a week. At this rate, results may start showing before these 60 days are up.
This rate of effectiveness, and the money-back guarantee must be why so many have endorsed the product. Legendary wide receiver, Jerry Rice, uses the belt himself. The concept of how it works is actually not too complicated. The Flex Belt employs three medical-grade Gel Pads.
These pads cover the abdominal and oblique muscles. Electric signals from The Flex Belt reach out to the nerves. These nerves branch out to the entire abdominal muscle system. Commercial weight-loss programs often provide various resources such as pre-packaged meals, support and more. Programs usually offer a 1, to 1, calorie-per-day diet plan which produces weight-loss of about pounds per week.
The slow-down of weight-loss is not unique to these approaches. It is true of any weight-loss program because as you begin to weight less, you burn fewer calories. Because commercial plans vary greatly, the FTC recommends asking the following questions before engaging in a program:. In this section, we will examine some of the most popular commercial weight-loss programs by separating them into two different categories: Meal Replacements Meal replacement through pre-packaged meals can be appealing because of the convenience and ease of choices they offer.
However, when meals are pre-packaged, participants may not learn the basics of nutrition and healthy eating. Pre-packaged meals may also be expensive this claim is dependent on the normal weekly food cost an individual could incur.
Liquid meal replacement plans, if used for too long, may be harmful because they can cause nutritional deficiencies. Unfortunately, when participants have not learned the principles of healthy eating and portion control, they often resume prior eating patterns.
Non-meal Replacements Some programs do not require meal replacement as part of their program. Their main goal is to teach you about healthy eating patterns, behavior modification and incorporating physical activity. While it is helpful long-term, behavior change does not happen overnight and can be a challenging adjustment at first.
Overall, a safe and effective commercial program will offer educational materials that have been reviewed by a licensed healthcare professional. These materials will include information on healthy eating plans, exercise and behavior therapy.
Nutrisystem features portion-controlled foods and structured meal plans that are both high in protein and low in glycemic index GI. Low-GI means means that the foods do not cause your blood sugar to rise sharply. For people with diabetes, a low-GI diet can help keep blood glucose in control. Nutrisystem plans, tailored for men and women, encourage you to consume three meals and two or three snacks per day.
The plans offer about different pre-packaged to choose from. Foods are home-delivered, typically in shipments every four weeks, after you place an order online or over-the-phone. You have to purchase additional fruits, vegetables and dairy products on your own. These are grouped into three categories: Smartcarbs nutrient-rich, high-fiber carbohydrates , PowerFuels lean proteins and healthy fats and vegetables non-starchy ones which can be eaten freely.
A meal planner explains how and when to add these foods into your diet. The program has an active online community, including discussion boards and dietitian-led chats. Counseling, for those who want it, is available and included with most Nutrisystem programs. With the recommended fruits, vegetables and dairy products, this diet plan can be considered well-balanced.
Research on Nutrisystem customers showed an average weight-loss of 18 pounds at three months and 27 pounds at six months. Some research finds a small weight-loss advantage for low-GI diets over high-GI ones, but other studies find no difference. So, this should be a healthy way to lose weight. Another concern is that participants using pre-packaged meals do not necessarily learn good nutrition, which makes maintaining weight-loss difficult once they return to buying food on their own.
Counselors are also available throughout the program and during transition and maintenance to educate about good eating habits. The final concern is the cost of the food. This does not include the additional fruits, vegetables and other foods that you must purchase on your own.
Although Nutrisystem claims that the full cost of eating while on the program is about 15 to 40 percent less than what the average American spends on food, some consumers would rather buy food week-to-week. Some employers and health plans subsidize or reimburse program costs. The program is developed by registered dietitians in consultation with an expert Science Advisory Board. The program is delivered by trained personal consultants in weekly motivational one-on-one consultations, in center, over the phone or via Skype.
Consultants partner with members to identify personal motivators, set weekly menu and activity plans, monitor progress, overcome obstacles and positively reinforce success. A typical menu day on Jenny Craig consists of three meals and three snacks per day, which, in combination with the added grocery items, adds up to an individualized menu calorie level that is based on your gender, age, height, weight and level of physical activity. The standard menu caloric distribution is percent carbohydrate, percent fat and percent protein.
For the Jenny Craig for type 2 diabetes menu, the caloric distribution is 45 percent carbohydrate, 30 percent fat and 25 percent protein. For the first half of your program, you primarily follow menus that include Jenny Craig foods for seven days a week. For special events or other times when you need an alternate option, your consultants will offer guidance for meals on your own.
When you have lost half of your total weight-loss goal, you make the transition to five to six days of menus that include Jenny Craig foods and one to two days of your own foods. Throughout your program, you work with your consultant to utilize behavioral strategies to address challenges like emotional, social and unconscious eating and dining out, as well as to build an enjoyable, active lifestyle.
Jenny Craig is a well-balanced, scientifically proven program on which you can expect to lose pounds per week on average. A clinical trial of people with type 2 diabetes demonstrated a 9 percent weight-loss at one year with greater improvements in diabetes control and heart risk factors as compared to usual care. For both programs, Jenny Craig participants achieved three times greater weight-loss when compared to usual care. The daily menu is a model for learning nutritional balance, variety and moderation in food choices.
Counselors are not dietitians.