#1 - The Energy Balance Equation Predicts Weight Gain and Weight Loss: But is There More to the Equation Than Calories in and Calories Out

I. Brief review of obesity and type 2 diabetes incidence throughout the world.

II. Perspective on the root causes of obesity including reductions in vocational/leisure time physical activity and availability of energy-dense foods

III. Review the energy balance equation: Calories in and Calories Out

IV. Address issues and misconceptions of the equation

V. Adipose tissue secreted proteins and essential amino acid restricted diets cause fat loss without changing energy intake or physical activity

VI. Dietary calorie restriction and weight loss maintenance

VII. Traditional and novel strategies to overcome weight re-gain following long-term dieting.

Behavioral/Learning Objectives:

1. Describe components of the energy balance equation and their relationship with the insidious incidence of obesity.
2. Explain the short-term success and long-term failure of caloric restriction.
3. Describe the role of adipose tissue-derived proteins and their potential as modulators of energy homeostasis.

#2 - Essential Amino Acid Restriction Reduces Diet-Induced Obesity and Insulin Resistance in Pre-clinical Trials

I. Restriction of essential amino acids increases lifespan in pre-clinical trials

II. Role in body fat loss with increased food intake

III. Role in lipid and glucose metabolism and improvements in insulin sensitivity

IV. Perspectives on the basis of essential amino acids as potent signals of energy balance

V. Review of known mechanisms of action

VI. Potential adverse effects of protein/essential amino acid restriction

VII. Essential amino acid restriction in humans

VIII. Review of vegan diets and development of novel essential amino acid restricted diets

IX. Role in prevention of type 2 diabetes, cardiovascular disease, Alzheimer’s, hepatic steatosis and cancer

Behavioral/Learning Objectives:

1. Explain the role of protein/essential amino acid restriction in lifespan extension.
2. Describe the potential mechanisms by which essential amino acid restriction diets reduce adiposity, decrease liver lipid content, and improve insulin sensitivity in preclinical trials.
3. Describe the clinical trial evidence in favor of essential amino acid restriction as a treatment for obesity and diabetes.

#3 - Bariatric Surgery Improves Insulin Sensitivity Prior to Significant Weight Loss: Current State of the Art

I. Brief historical perspective of bariatric surgery.

II. Review of jejuno ileal, roux-en-y gastric bypass, and lap band surgeries.

III. Review of post-surgical care and adverse effects.

IV. Mechanical restriction of energy absorption and food aversion.

V. Post-surgery changes in gut hormones.

VI. Influence of incretins and other gut hormones on food intake and metabolism 7. Pharmacological and nutritional manipulation of gut hormone secretion without bariatric surgery.

Behavioral/Learning Objectives:

1. Identify the various forms of bariatric surgery and present the benefits and risks associated with each.
2. Explain the current mechanisms by which bariatric surgery is thought to reverse type 2 diabetes.
3. Describe what we have learned from bariatric surgery and how our understanding of the surgery may transform the way we treat patients with diabetes who are not candidates for bariatric surgery.

#4 - Complementary Medical Therapies for Diabetes

I. Background definition of complementary medicine

II. NIACR1 (niacin) receptor agonists role in regulating adipokines and lipolysis

III. Adverse effects

IV. Development of novel agonists with reduced adverse effects

V. Review the role of chromium as a trace element

A. Role of chromium in glucose metabolism
B. Mechanisms of action
C. Guidelines for patients taking chromium

VI. Omega-3 fatty acid availability

A. Mechanisms of action
B. Review of pre-clinical and clinical trials

VII. Blueberry polyphenols

A. Role in prevention of insulin resistance
B. Review of pre-clinical and clinical trials

Behavioral/Learning Objectives:

1. Define complementary medicine and the overall impact of so-called nutraceuticals and botanicals in the treatment of diabetes.
2. Describe the mechanisms by which niacin receptor agonists, chromium, n-3 fatty acids and blueberries work in the treatment of diabetes.
3. Describe current and upcoming clinical trials using these complementary therapies.

#5 - Brown Adipose Tissue as a Target for Obesity and Diabetes

I. Review functional components of fat deposition and body weight gain.

II. Compare white fat cells to brown fat cell.

III. Thermogenic function of brown fat.

IV. Presence and potential role in humans.

V. Deletion of brown fat in animals.

VI. Increasing brown fat.

VII. Metabolic ineffieniency and uncoupling proteins.

VIII. β3-adrenergic agonists

A. Development of safe and efficacious nutritional approaches to increase β3-specific agonism.

Behavioral/Learning Objectives:

1. Identify the different types of adipose (fat) tissue in humans and their role in energy balance.
2. Describe the role of uncoupling protein 1 (UCP1) in adipose tissue and attempts to target this protein with nutritional and pharmacological approaches as a treatment for diabetes.
3. Describe the development of β3-specific adrenergic agonists and activation of UCP1 in preclinical and clinical trials.

#6 - Personalized Medicine

I. Discuss importance of personalizing or individualizing medical treatments

II. Responders and non-responders

III. Generally accepted as biological variability

IV. Non-responder information

V. Pharmacogenetic studies

VI. Examine variability of responses between individuals

VII. Personalizing medicine

VIII. Collection of tissue and/or blood sample

IX. Genotyping services

X. Increasing feasibility in clinical practice.

Behavioral/Learning Objectives:

1. Describe the common observation in medical treatments that some patients respond while others do not respond to treatments.
2. Identify how a growing field of pharmacogenetics is trying to harness biochemical and molecular information from nonresponders to develop a new wave of drug treatment strategies for diabetes and other chronic disease conditions.
3. Explain what personalized medicine can look like in practice and the logistics and cost to our patients.
   

Accreditation Information

Nurses – Academy Medical Systems is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

Academy Medical Systems (AMS) is also a provider approved by the California Board of Registered Nursing, provider #CEP14413.

AMS is also a provider approved by the Florida Board of Nursing, provider #50-19.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Certified Diabetes Educators – Academy Medical Systems' approved Provider Status with the ANCC (nurses) and the CDR (dietitians) is recognized by the National Certification Board of Diabetes Educators (NCBDE).

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470. This course is an intermediate education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs and PTAs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, AL, AZ, CA, CO, CT, GA (Class 1), HI, IA, ID, IN, KS (Cat 2), KY, MA, ME, MI, MN (Cat 2), MO, MS, MT, NE, NM, ND, OK (Cat 2), OR, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WI, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10. The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, OK (Cat 2), WI.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.  See The Federation of State Boards of Physical Therapy website for more information.

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