In re Edna MF: Case Law Confusion in Surrogate Decision Making

I review the recent case of Edna Folz, a 73 year-old woman who was suffering through the end stages of very advanced Alzheimer's dementia when her case was adjudicated by the Wisconsin Supreme Court. I consider this case as an example of how courts are increasingly misinterpreting the ethical and legal decision-making standards known as substituted judgment and best interests and thereby threatening individuals' treatment decision-making rights as developed by other courts over the past two decades and creating serious roadblocks to health-care providers' ability to render appropriate patient care. The Wisconsin Supreme Court held that Edna's legal guardian could not authorize withdrawal of Edna's treatment, ruling that as a matter of law, if an incompetent person is not in a persistent vegetative state, it is not in his or her best interests for life-sustaining treatment to be withdrawn unless (s)he has executed an advance directive or other statement clearly indicating his or her desires.     

Eating patterns and breakfast consumption in obese patients with binge eating disorder

This study examined eating patterns and breakfast consumption, and their relationships to weight and binge eating, in obese individuals with binge eating disorder (BED). One-hundred seventy-three consecutively evaluated men (n=46) and women (n=127) with BED were administered semi-structured interviews and self-report measures to assess the frequency of meals and snacks eaten, as well as binge eating and eating disorder features. Overall, those who consumed more frequent meals, particularly breakfast, and snacks, weighed less. Breakfast, which was eaten on a daily basis by less than half of participants (n=74; 43%), was the least frequently eaten meal of the day. Participants (n=56; 32%) who ate three meals per day weighed significantly less, and had significantly fewer binges, than participants (n=117; 68%) who did not regularly eat three meals per day. Thus, eating more frequently, having breakfast and consuming three meals every day, have potentially important clinical applications for the treatment of BED given that the effectiveness of specific interventions within treatments for BED are unknown, and that weight loss outcome for BED has been poor.     

The Impact of Teasing on Children’s Body Image

Being teased about one’s physical appearance in childhood has been found to have a strong impact on the way in which adolescent and adult women perceive their bodies. Teasing is also strongly related to self-esteem in children. However, little is known about the impact of teasing on the development of body image in childhood. Through a quantitative study of the experience of being teased and body image satisfaction in a group of 431 primary aged children, we examined the prevalence, type and impact of teasing on children’s perceived body image satisfaction. The results of our study indicated that many children, especially those who are over or underweight experience being teased. This experience does have a negative impact on children’s body image. This is especially significant for young girls and boys who are overweight. Underweight young boys also suffer negatively from this experience. It is important for parents and others to understand that what may be perceived as friendly banter with their children may not necessarily be innocuous. Further research exploring the concept and construct of teasing in childhood is warranted.     

A randomized controlled trial on the long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice

OBJECTIVES: To examine the long-term effects of a new behavioral weight control program (Kenkou-tatsujin, KT program). The program consisted of twice-interactive letter communications including computer-tailored personal advice on treatment needs and behavioral modification. DESIGN: A randomized controlled trial comparing Group KM: KT program with 6-month weight and targeted behavior's self-monitoring, Group K: KT program only, Group BM: an untailored self-help booklet with 7-month self-monitoring of weight and walking, and Group B: the self-help booklet only. PARTICIPANTS: Two hundreds and five overweight Japanese females were recruited via a local newspaper. MEASUREMENTS: Weight loss (body weight, BMI, reduction quotient, etc.) and behavioral changes (daily eating, exercise and sleeping habits). FINDINGS: A significant weight loss was observed in all groups. At 1 month, Groups KM and K were superior, but at 7 months, the mean weight loss was significantly more in Group KM than the other 3 groups. At 7 months, 8 dietary habits and 4 physical activities were improved in all subjects. Habitual improvement was related to the weight loss in Groups KM and K at 1 month.     

Frequency and pattern of voluntary pedalling is influenced after one week of heavy strength training

Changes in voluntary rhythmic leg movement characteristics of freely chosen cadence (reflecting movement frequency) and tangential pedal force profile (reflecting movement pattern) were investigated during 4 weeks of (i) heavy hip extension strength training (HET, n = 9), (ii) heavy hip flexion strength training (HFT, n = 9), and (iii) no intervention (CON, n = 9). Training consisted of three 5RM–10RM sets per session, with two sessions/week. Submaximal ergometer cycling was performed before the training period (pretest) and after every week of training (test A1, A2, A3, and posttest). Strength increased by on average 25% in HET and 33% in HFT. Freely chosen cadence was only changed in HET, occurring already after 1 week of training. Thus, percentage reductions of cadence in HET at test A1, A2, A3, and posttest, with respect to the pretest value, amounted for maximally on average 17%, or 14 rpm, and were larger than the corresponding changes in CON (p = .037). Percentage increases in minimum tangential pedal force in HET at test A1, A2, A3, and posttest, with respect to the pretest value, were larger than the corresponding changes in CON (p = .024). Heavy hip flexion strength training did not cause such alterations.     

Good intentions gone awry? Effects of weight-related social control on health and well-being

A negative body image has been associated with a variety of negative health and well-being outcomes. Social pressures from others, in the form of weight-related social control, may serve to exacerbate this effect, especially for college-aged women. Undergraduate students (N = 399) completed a variety of questionnaires assessing weight-related social control, well-being, and diet and exercise behaviors. The results suggest that weight is associated with a variety of negative health and well-being outcomes and particularly for women, weight-related social control is also associated with these negative effects. In addition, men of higher body mass indexes (BMIs) or higher self-perceived weight did not experience negative health and well-being outcomes to the same degree that overweight women did. Parents in particular seem to instigate weight-related social control to change students’ diet and exercise behaviors. These results help clarify the effects of weight-related social control in a college population, where weight may be especially important.     

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants

ObjectiveThe aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants.MethodsForty-four healthy preterm infants with a corrected gestational age of 30–36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups.ResultsDuring the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly.ConclusionOur findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants’ weight gain and decreases their duration of NICU stay significantly.     

A Stronger Doctrine of Double Effect

Many believe that intended harms are more difficult to justify than are harms that result as a foreseen side effect of one's conduct. We describe cases of harming in which the harm is not intended, yet the harmful act nevertheless runs afoul of the intuitive moral constraint that governs intended harms. We note that these cases provide new and improved counterexamples to the so-called Simple View, according to which intentionally phi-ing requires intending to phi. We then give a new theory of the moral relevance of intention. This theory yields the traditional constraint on intending harm as a special case, along with several stronger demands.     

Appearance vs. health motives for exercise and for weight loss

Objective

This study had three primary aims: (1) to investigate differences between restrained and unrestrained eaters in their reasons for exercise and their motives for losing weight; (2) to investigate the association of appearance and health motives for exercise and for losing weight with body image concerns; and (3) to determine whether appearance motives for exercise and for losing weight mediate the link between internalized societal standards of attractiveness and body image concerns.

Design

Cross-sectional survey.

Method

205 women completed measures of dietary restraint, reasons for exercise, motivation for losing weight, internalization of societal standards of attractiveness, and body image concerns.

Results

Unrestrained eaters were more motivated to exercise and to lose weight for health reasons than for appearance reasons, whereas restrained eaters were equally motivated by appearance and health reasons. Appearance-based motives for exercising and for losing weight were positively associated with body image concerns, whereas health-related reasons for exercise were negatively associated with body image concerns. Furthermore, in a multiple mediation analysis, appearance motives for weight loss mediated the relation between internalization of societal standards of attractiveness and body image concerns, but appearance reasons for exercise did not.

Conclusion

These findings indicate that appearance-based motives for exercise and weight loss are associated with negative outcomes. Efforts to promote exercise and weight management should emphasize the health benefits rather than the implications for appearance.