ENG101 Auburn University Obesity in Children Project This project will be in the form of a report addressed to your primary audience, describing your under

ENG101 Auburn University Obesity in Children Project This project will be in the form of a report addressed to your primary audience, describing your understanding of the problem, the research you’ve undertaken, and, most importantly and significantly, suggesting a course of action your audience should follow to amend or improve the problem you’ve identified. Specifically, the Final Project will be comprised of the following:-Primary Audience Description -Final Project (problem/solution, min. 8 double-spaced pages of content)-Properly formatted list of 10 sourcesUse attached file as your outline English 393 Online Summer
Final Project
Requirements
This project will be in the form of a report addressed to your primary audience, describing your
understanding of the problem, the research you’ve undertaken, and, most importantly and significantly,
suggesting a course of action your audience should follow to amend or improve the problem you’ve
identified. Specifically, the Final Project will be comprised of the following:
The Report (Minimum 3000 words/10 full pages of double-spaced text equivalent)
Problem:
? Introduction of the problem/topic, describing your understanding of it and paying close
attention to your audience’s needs, knowledge and area of focus, supported by research
Solution:
? Recommendations based on your research, described in detail; this could include sample
manual pages, brochures, agendas, potential budgets, funding sources, and any other
supporting information your solutions need
? Conclusion stating what steps your audience needs to take
Addendum
Front Matter:
? Cover Letter addressed to your primary audience
? Cover Page & Table of Contents
Back Matter:
? Works Consulted List (a bibliography of your ten+ sources, updated from Outline)
? If appropriate, relevant, audience-appropriate graphics that don’t fit into the text itself
? Glossary of Terms, if necessary
? If conducted, evidence of primary research
Please note:
? You must fulfill all components of the assignment to receive a passing grade.
? You’ll be graded not only on the scope of your research, your attention to your audience’s needs,
the feasibility of your solution, and the tangible results of your work, but on overall organization,
clarity, and cohesiveness. This includes using correct grammar and carefully proof-reading all
documents.
Draft Workshop Please see our course space for specific details about draft workshop requirements.
Citations When using specific evidence and information from other people’s work, you must provide
correct in-text citations. Please see the Research page on our website for a refresher on citations; if you
use a style for citations other than MLA, please include a notation in your Memo identifying exactly which
style guide you are using.
Explanation of Addendum
Memo You’ll submit a final memo that will cover your work for the project with your work for the course.
It is detailed in a separate assignment sheet and may be submitted separately.
Cover Letter Your cover letter will be addressed to your primary audience. It will introduce your
credentials, and serve as a pitch – a brief, attention-grabbing description — of your final project. Please
review our Audience-Based Cover Letter discussion for advice.
Cover Page Simply a one-page document with your project title, your primary audience’s name, and your
name. You may add other essential information you find necessary, and/or graphics.
Table of Contents This should include all Report sections, in-text graphics, and back matter items. As the
cover letter, memo, and cover page are attached to the report and not part of the report itself, they do
not need to be included on the Table of Contents.
Evidence of Primary Research If you complete primary research, please provide interview transcripts
and/or survey tabulations for each interview or survey completed.
Graphics You’ll want to include charts, graphs, images, or other supporting visual data appropriate for
your audiences’ needs (you are encouraged to include graphics used in your project presentation, if your
audiences will find them useful). All graphics must be properly attributed.
Glossary of Terms (Optional) You may find it useful to include a glossary for terms that may be unfamiliar
to any members of your primary, secondary, or tertiary audiences, as well as incidental audiences (mainly,
me).
English 393 Online Summer
Project Outline & Working Bibliography
Your Name:
Your Project:
Decision-Maker Audience (Name, Job title):
PROBLEM, Section One (Introduction)
Section Goal: demonstrate your understanding of the problem, the context, and audience’s needs; provide information about your
research; provide exigence for the project; attend to the status quo and/or connect to big-picture issues
Key Points to Make:
Sources to Cite:
Show Awareness of Audience By:
Approximate Number of Pages or Words:
SOLUTION, Section Two (Recommendations)
Section Goal: describe your solutions and recommendations in detail, with plenty of support from your research.
Key Points to Make:
Sources to Cite:
Show Awareness of Audience By:
Approximate Number of Pages or Words:
SOLUTION, Section Three (Conclusion)
Section Goal: Where does your audience go from here? What steps should they take? What do they need to do to enact your
solutions?
Key Points to Make:
Approximate Number of Pages or Words:
Working Bibliography/Works Consulted List
Attach a properly-formatted list of at least ten sources. Review course guidelines for requirements.
[Redacted]
December 13, 2013
Catherine Herrick
Diabetes Prevention Program
Holy Cross Hospital Senior Source
8580 Second Ave.
Silver Spring, MD 20910
Re:
Proposal for Program Enhancement – Mindful Eating
Dear Ms. Herrick:
I am pleased to present to you a proposal that I believe will enhance the
effectiveness of the Diabetes Prevention Program at Holy Cross Hospital. As you know,
I am a Dietetics student at the University of Maryland, and I have been a volunteer with
the program since July of 2013. My research regarding mindful eating and its application
for preventing diabetes has convinced me that incorporating instruction in mindful eating
into the curriculum for the program would substantially increase the program’s
effectiveness.
Thank you for taking the time to read and consider my proposal. If you have any
questions or comments, please do not hesitate to contact me, and I would be happy to
discuss this matter with you further.
Regards,
[Redacted]
Preventing Diabetes with Mindful Eating:
A Proposal for Enhancing the Holy Cross Hospital Diabetes Prevention Program
Prepared for Catherine Herrick
By [Redacted]
December 13, 2013
Table of Contents
Introduction ………………………………………………………………………………………………………………… 1
Overview of the Diabetes Prevention Program ………………………………………………………….. 2
How Effective is the Diabetes Prevention Program? …………………………………………………. 3
The Challenge of Change …………………………………………………………………………………………….. 5
Mindfulness: a Tool for Transformation …………………………………………………………………….. 7
Research on the Effectiveness of Mindfulness-Based Strategies ………………………………. 7
Why Does Mindfulness Work? ……………………………………………………………………………………. 9
Recommendations ……………………………………………………………………………………………………..10
Training Instructors ……………………………………………………………………………………………………….. 11
Meditation ………………………………………………………………………………………………………………………… 11
Mindful Eating………………………………………………………………………………………………………………….. 12
Yoga …………………………………………………………………………………………………………………………………… 13
Curriculum ……………………………………………………………………………………………………………………….. 15
Conclusion ………………………………………………………………………………………………………………….16
Appendices:
Sample Handouts …………………………………………………………………………………………………………….. 17
Works Consulted ……………………………………………………………………………………………………………… 21
Interview Transcripts …………………………………………………………………………………………………….. 24
Introduction
Reducing the incidence of diabetes continues to present one of the major
public health challenges of our time. According to the Centers for Disease Control
and Prevention’s 2011 National Diabetes Fact Sheet, about 26 million people in the
US are living with diabetes, and about 2 million more are diagnosed every year.
Diabetes afflicts almost 27% of those over the age of 65 and more than 11% of
those over 20. About 35% of US adults over 20 are estimated to be prediabetic.
Type 2 diabetes accounts for more than 90% of cases of diabetes, according
to the 2011 CDC Fact Sheet. Luckily, Type 2 diabetes is a disease that is highly
responsive to lifestyle interventions. The Diabetes Prevention Program at Holy
Cross Hospital (hereafter, the “DPP”) has the potential to make a significant impact
on this critical public health issue by providing effective guidance and motivation
for prediabetic individuals to make long-term behavioral changes that may slow the
progression of their disease to full-blown diabetes, and possibly even reverse their
disease process.
Unfortunately, lifestyle changes are notoriously difficult to make, and even
more notoriously difficult to sustain over the long-term. Physiological,
psychological, and environmental factors can impede an individual’s ability to
choose new behaviors and to commit to making those choices for the rest of his or
her life, even given a life-altering medical diagnosis such as prediabetes or diabetes.
Given these challenges, how can the DPP maximize its effectiveness at preventing
and reversing the progression from prediabetes to diabetes?
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This report explores the particular challenges faced by individuals
attempting to make long-term lifestyle changes in order to manage prediabetes and
prevent progression to diabetes, and proposes that the practice of mindfulness, a
concept drawn from Eastern spiritual traditions such as Buddhism, may offer a tool
for addressing these challenges. After presenting the evidence for the effectiveness
of this tool, I will describe in practical detail how it can be incorporated into the
existing curriculum of the DPP in order to enhance the successfulness of the
program.
Overview of the DPP
The DPP is modeled after the lifestyle intervention used in the landmark
study by the Diabetes Prevention Program Research Group, published in the New
England Journal of Medicine in 2002, which demonstrated that lifestyle changes
could reduce the incidence of diabetes by 58% among prediabetic individuals. The
lifestyle modification program in the study provided one-on-one personalized
support and education to participants, and encouraged them to reduce their body
weight by 7% and perform 150 minutes of physical activity per week. This
intervention was more effective at preventing progression to diabetes than a drug
treatment, metformin, which only reduced the incidence of diabetes by 31%
(Diabetes Prevention Program Research Group, “Reduction in the Incidence of Type
2 Diabetes,” 393). The curriculum of the DPP is designed to resemble that used in
the 2002 study, although the one-on-one, personalized method of the original study
is replaced by weekly group instructional sessions.
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How Effective is the DPP?
Statistics from the most recent fiscal year suggest that the DPP at HCH is
moderately but not overwhelmingly successful. In the 2013 fiscal year, about half of
participants exhibited reductions in fasting blood glucose levels immediately
following completion of the program; the other half exhibited slight increases.
About two-thirds of participants exhibited reductions in HbA1c levels immediately
following program completion; the remaining one-third exhibited slight increases.
Data was not available on how many participants achieved weight loss or physical
activity goals. Because data is only collected at the start and end of the twelve-week
program, the long-term impact of participation can not be assessed. Based on this
admittedly limited data, we can reasonably conclude that, overall, somewhere
between one-half and two-thirds of participants are at least temporarily successful
in slowing or possibly reversing their disease progression from prediabetes to fullblown diabetes.
Based on the data available to us, it is impossible to say with certainty
whether these gains are maintained beyond the end of the twelve-week program.
We can, however, look at the follow up research conducted by the Diabetes
Prevention Program Research Group on their participants. Ten years after their
original study, the Diabetes Prevention Program Research Group examined the longterm impact of their interventions on participants in their study. Individuals who
lost weight during the original 2.8 year study period subsequently regained some,
but not all, of that weight. Rates of diabetes incidence among individuals who
received the lifestyle intervention, those who received metformin, and those in the
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placebo control group were similar in the years following the intervention, although
overall diabetes incidence remained reduced in the lifestyle and metformin groups
(Diabetes Prevention Program Research Group, “Ten Year Follow Up,” 1677).
Another study, by Davis and colleagues, examined the energy and fat intake
of participants who received the lifestyle intervention nine years after the original
study. Initially, participants receiving the lifestyle intervention reduced their energy
and fat intake during the intervention. In the 9 years that followed, energy and fat
intake increased, although they never returned to baseline, pre-study levels. Those
participants who were most successful at reducing their energy and fat intake
during the original study showed the most continued success in the nine years that
followed, while those who were less successful during the period of the initial study
continued to exhibit less reductions in the years that followed (1461-1463).
These results suggest that participants who successfully make lifestyle
changes and who experience delayed or arrested disease progression during the
period of the original 12- or 16-week lifestyle intervention program may continue
to successfully manage prediabetes, and that lifestyle changes, although they are not
maintained at the level achieved during the initial intervention, may continue to
exert a lasting effect.
How can we broaden the impact of the diabetes prevention program so that
more than one-half to two-thirds of participants achieve significant reductions in
disease progression during the period of the intervention? And how can we help
participants maintain their lifestyle changes beyond the period of the initial
intervention? In order to answer these questions, it is useful to consider the
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obstacles that commonly prevent individuals from making and sustaining lifestyle
changes.
The Challenge of Change
The lifestyle changes that bring about weight loss and reduced chronic
disease risk are notoriously difficult to make and often unsustainable. Why is this
the case?
Dorothy Van Buren and Meghan Sinton, in their commentary on the research
regarding the psychology of weight maintenance published in the Journal of the
American Dietetic Association, note that our bodies evolved to cope with scarcity as
a survival strategy. Thus, the body’s homeostatic system, which controls appetite,
and the limbic system, which regulates emotion, are evolutionarily programmed to
be averse to weight-loss behaviors, including reduced calorie intake and increased
physical activity. In practical terms, this means that individuals who attempt to lose
weight are likely to experience discomfort, both physical and psychological (Van
Buren and Sinton 1994). This discomfort must be addressed in order for
participants to make permanent lifestyle changes.
Not surprisingly, research shows that high levels of emotional stress and the
presence of significant stressors such as major life changes generally correlate with
more difficulty losing and maintaining weight (Elfhag and Rossner 71-72). In an
interview, Julia Mutter, dietitian and Certified Diabetes Educator, who has been an
instructor for the DPP for a number of years, identified the presence of stressful life
circumstances as one of the main obstacles that prevents some DPP participants
from meeting goals:
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… sometimes people have a really bad family dynamic, they have a lot of
stress going on so they can’t focus on their health in particular. We have
people dropping out because they have to take care of other people, you
know, if someone else in the family is sick or they have kids.
Eating provides us with nourishment, not just physically but psychologically as well.
Lifestyle changes that involve reducing overall food intake may be experienced by
program participants as painful self-denial. Often, individuals who are diagnosed
with diabetes or prediabetes already have a strained relationship with food, as
evidenced by the high prevalence of binge eating disorder among those diagnosed
with type 2 diabetes (Crow, Kendall, Praus, and Thuras 222). It is not unusual for
individuals with weight-related health problems such as prediabetes and diabetes to
cycle through a pattern of a period of overly restrictive eating followed by a period
of excessive, unrestrained eating, and each turn of this cycle can result in intense
feelings of guilt, self-judgment, and powerlessness (May and Fletcher 17).
The current DPP curriculum provides ample information on nutritional
topics, covering calorie balance, food groups, calorie and fat content of various
foods, portion control, and other similar nutritional topics. Practical advice is
provided on how to go about incorporating physical activity into one’s daily life.
Certain behavioral strategies, including awareness of social and environmental
eating cues and problem solving, are also offered. However, these strategies may be
insufficient to address the profound psychological challenges that are inherent to
the weight-loss process. How can the psychological challenge be addressed?
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Mindfulness: a Tool for Transformation
Mindfulness has its roots in the meditative traditions of the Buddhist
religion, particularly in Japanese Zen Buddhism, but in the West it is often taught
and used in a secular fashion. Definitions of mindfulness generally contain two
components: (i) a sustained attentiveness to the present moment, and (ii) an
attitude of openness and non-judgmental acceptance (Bishop, et al, 232).
Mindfulness can be used as a technique for traditional seated meditation, in which
the practitioner sits in silence and practices training his or her attention on his or
her moment-to-moment experience. As thoughts or bodily sensations arise, they
are acknowledged without being labeled “good” or “bad,” and then the practitioner
releases the thought and returns his or her attention to the present moment.
Mindfulness can also be practiced in all of the activities of daily living. Walking,
engaging in conversation, eating, performing work or chores, and any other task
may be performed with the same attentiveness to the present moment, and the
same open, accepting attitude towards any and all experiences and thoughts. Most
instruction in mindfulness, whether religious or secular, emphasizes the importance
and the mutual complementarity of both the traditional meditation practice as well
as the use of mindfulness as a tool for the activities of daily life …
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