Ace homework tutors – APA Research Paper (Mirano)

Ace homework tutors – APA Research Paper (Mirano)
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
This paper follows the style guidelines in the Publication Manual of the American Psychological Association, 6th ed.
(2010 – Essay Writing Service: Write My Essay by Top-Notch Writer).
Obesity in Children i
Can Medication Cure Obesity in Children?
A Review of the Literature
Luisa Mirano
Psychology 107, Section B
Professor Kang
October 31, 2004
Short title and
page number for
student papers.
Full title.
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Marginal annotations indicate Ace homework tutors – APA-style formatting and effective writing.
Obesity in Children 1
Ace my homework – Writer’s name,
course, section
number, instructor’s
name, and date
(all centered).
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Abstract appears on
a separate page.
Obesity in Children 2
Abstract
In recent years, policymakers and medical experts have
expressed alarm about the growing problem of childhood obesity
in the United States. While most agree that the issue deserves
attention, consensus dissolves around how to respond to the
problem. This literature review examines one approach to treating
childhood obesity: medication. The paper compares the
effectiveness for adolescents of the only two drugs approved by
the Food and Drug Administration (FDA) for longterm treatment
of obesity, sibutramine and orlistat. This examination of
pharmacological treatments for obesity points out the limitations
of medication and suggests the need for a comprehensive solution
that combines medical, social, behavioral, and political approaches
to this complex problem.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Full title, centered.
The writer uses a
footnote to define
an essential term
that would be cumbersome to define
within the text.
The writer sets
up her organization by posing four
questions.
The writer states
her thesis.
Obesity in Children 3
Can Medication Cure Obesity in Children?
A Review of the Literature
In March 2004, U.S. Surgeon General Richard Carmona
called attention to a health problem in the United States that,
until recently, has been overlooked: childhood obesity. Carmona
said that the “astounding” 15% child obesity rate constitutes
an “epidemic.” Since the early 1980s, that rate has “doubled in
children and tripled in adolescents.” Now more than nine million
children are classified as obese.1 While the traditional response
to a medical epidemic is to hunt for a vaccine or a cure-all pill,
childhood obesity has proven more elusive. The lack of success
of recent initiatives suggests that medication might not be the
answer for the escalating problem. This literature review considers
whether the use of medication is a promising approach for solving
the childhood obesity problem by responding to the following
questions:
1. What are the implications of childhood obesity?
2. Is medication effective at treating childhood obesity?
3. Is medication safe for children?
4. Is medication the best solution?
Understanding the limitations of medical treatments for
children highlights the complexity of the childhood obesity
problem in the United States and underscores the need for
1Obesity is measured in terms of body-mass index (BMI):
weight in kilograms divided by square of height in meters. A child
or an adolescent with a BMI in the 95th percentile for his or her
age and gender is considered obese.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Headings, centered,
help readers follow
the organization.
In a signal phrase,
the word “and”
links the names of
two authors; the
date is given in
parentheses.
Because the
author (Carmona)
is not named in
the signal phrase,
his name and the
date appear in
parentheses.
Obesity in Children 4
physicians, advocacy groups, and policymakers to search for
other solutions.
What Are the Implications of Childhood Obesity?
Obesity can be a devastating problem from both an
individual and a societal perspective. Obesity puts children at risk
for a number of medical complications, including type 2 diabetes,
hypertension, sleep apnea, and orthopedic problems (Henry J.
Kaiser Family Foundation, 2004, p. 1). Researchers Hoppin and
Taveras (2004) have noted that obesity is often associated with
psychological issues such as depression, anxiety, and binge eating
(Table 4).
Obesity also poses serious problems for a society
struggling to cope with rising health care costs. The cost of
treating obesity currently totals $117 billion per year—a price,
according to the surgeon general, “second only to the cost of
[treating] tobacco use” (Carmona, 2004). And as the number of
children who suffer from obesity grows, long-term costs will
only increase.
Is Medication Effective at Treating Childhood Obesity?
The widening scope of the obesity problem has prompted
medical professionals to rethink old conceptions of the disorder
and its causes. As researchers Yanovski and Yanovski (2002) have
explained, obesity was once considered “either a moral failing or
evidence of underlying psychopathology” (p. 592). But this view
has shifted: Many medical professionals now consider obesity a
biomedical rather than a moral condition, influenced by both
genetic and environmental factors. Yanovski and Yanovski have
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Ellipsis mark
indicates omitted
words.
An ampersand
links the names of
two authors in
parentheses.
The writer draws
attention to an
important article.
Obesity in Children 5
further noted that the development of weight-loss medications in
the early 1990s showed that “obesity should be treated in the
same manner as any other chronic disease . . . through the
long-term use of medication” (p. 592).
The search for the right long-term medication has been
complicated. Many of the drugs authorized by the Food and
Drug Administration (FDA) in the early 1990s proved to be a
disappointment. Two of the medications—fenfluramine and
dexfenfluramine—were withdrawn from the market because of
severe side effects (Yanovski & Yanovski, 2002, p. 592), and
several others were classified by the Drug Enforcement
Administration as having the “potential for abuse” (Hoppin &
Taveras, 2004, Weight-Loss Drugs section, para. 6). Currently only
two medications have been approved by the FDA for long-term
treatment of obesity: sibutramine (marketed as Meridia) and
orlistat (marketed as Xenical). This section compares studies on
the effectiveness of each.
Sibutramine suppresses appetite by blocking the reuptake
of the neurotransmitters serotonin and norepinephrine in the
brain. Though the drug won FDA approval in 1998, experiments
to test its effectiveness for younger patients came considerably
later. In 2003, University of Pennsylvania researchers
Berkowitz, Wadden, Tershakovec, and Cronquist released the
first double-blind placebo study testing the effect of sibutramine
on adolescents, aged 13-17, over a 12-month period. Their
findings are summarized in Table 1.
After 6 mos.:
loss of 3.2 kg
(7 lb)
After 12 mos.:
loss of 4.5 kg
(9.9 lb)
After 6 mos.:
loss of 7.8
kg (17.2 lb)
After 12 mos.:
loss of 7.0
kg (15.4 lb)
Gain of 0.67
kg (1.5 lb)
Loss of 1.3
kg (2.9 lb)
Table 1
Effectiveness of Sibutramine and Orlistat in Adolescents
Average
weight
Medication Subjects Treatmenta Side effects loss/gain
Sibutramine
Orlistat
Control
Medicated
Control
Medicated
0-6 mos.:
placebo
6-12 mos.:
sibutramine
0-12 mos.:
sibutramine
0-12 mos.:
placebo
0-12 mos.:
orlistat
Mos. 6-12:
increased
blood pressure;
increased pulse
rate
Increased
blood pressure;
increased pulse
rate
None
Oily spotting;
flatulence;
abdominal
discomfort
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
The writer uses a
table to summarize the findings
presented in two
sources.
A note gives the
source of the data.
A content note
explains data
common to
all subjects.
Note. The data on sibutramine are adapted from “Behavior Therapy and
Sibutramine for the Treatment of Adolescent Obesity,” by R. I. Berkowitz,
T. A. Wadden, A. M. Tershakovec, & J. L. Cronquist, 2003, Journal of
the American Medical Association, 289, pp. 1807-1809. The data on
orlistat are adapted from Xenical (Orlistat) Capsules: Complete Product
Information, by Roche Laboratories, December 2003, retrieved from
http://www.rocheusa.com/products/xenical/pi.pdf
aThe medication and/or placebo were combined with behavioral therapy
in all groups over all time periods.
Obesity in Children 6
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
When this article
was first cited, all
four authors were
named. In subsequent citations of
a work with three
to five authors,
“et al.” is used
after the first
author’s name.
Obesity in Children 7
After 6 months, the group receiving medication had lost
4.6 kg (about 10 pounds) more than the control group. But
during the second half of the study, when both groups received
sibutramine, the results were more ambiguous. In months 6-12,
the group that continued to take sibutramine gained an average
of 0.8 kg, or roughly 2 pounds; the control group, which switched
from placebo to sibutramine, lost 1.3 kg, or roughly 3 pounds
(p. 1808). Both groups received behavioral therapy covering diet,
exercise, and mental health.
These results paint a murky picture of the effectiveness
of the medication: While initial data seemed promising,
the results after one year raised questions about whether
medicationinduced weight loss could be sustained over time.
As Berkowitz et al. (2003) advised, “Until more extensive
safety and efficacy data are available, . . . weight-loss
medications should be used only on an experimental basis
for adolescents” (p. 1811).
A study testing the effectiveness of orlistat in adolescents
showed similarly ambiguous results. The FDA approved orlistat
in 1999 but did not authorize it for adolescents until December
2003. Roche Laboratories (2003), maker of orlistat, released
results of a one-year study testing the drug on 539 obese
adolescents, aged 12-16. The drug, which promotes weight loss by
blocking fat absorption in the large intestine, showed some
effectiveness in adolescents: an average loss of 1.3 kg, or
roughly 3 pounds, for subjects taking orlistat for one year, as
opposed to an average gain of 0.67 kg, or 1.5 pounds, for the
control group (pp. 8-9). See Table 1.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
For a source with
six or more
authors, the first
author’s name
followed by “et al.”
is used for the first
and subsequent
references.
Obesity in Children 8
Short-term studies of orlistat have shown slightly more
dramatic results. Researchers at the National Institute of Child
Health and Human Development tested 20 adolescents, aged
12-16, over a three-month period and found that orlistat,
combined with behavioral therapy, produced an average weight
loss of 4.4 kg, or 9.7 pounds (McDuffie et al., 2002, p. 646).
The study was not controlled against a placebo group; therefore,
the relative effectiveness of orlistat in this case remains
unclear.
Is Medication Safe for Children?
While modest weight loss has been documented for both
medications, each carries risks of certain side effects.
Sibutramine has been observed to increase blood pressure and
pulse rate. In 2002, a consumer group claimed that the
medication was related to the deaths of 19 people and filed a
petition with the Department of Health and Human Services to
ban the medication (Hilts, 2002). The sibutramine study by
Berkowitz et al. (2003) noted elevated blood pressure as a side
effect, and dosages had to be reduced or the medication
discontinued in 19 of the 43 subjects in the first six months
(p. 1809).
The main side effects associated with orlistat were
abdominal discomfort, oily spotting, fecal incontinence, and
nausea (Roche Laboratories, 2003, p. 13). More serious for
long-term health is the concern that orlistat, being a fatblocker, would affect absorption of fat-soluble vitamins, such
as vitamin D. However, the study found that this side effect
can be minimized or eliminated if patients take vitamin
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
The writer
develops the
paper’s thesis.
Obesity in Children 9
supplements two hours before or after administration of orlistat
(p. 10). With close monitoring of patients taking the medication,
many of the risks can be reduced.
Is Medication the Best Solution?
The data on the safety and efficacy of pharmacological
treatments of childhood obesity raise the question of whether
medication is the best solution for the problem. The
treatments have clear costs for individual patients, including
unpleasant side effects, little information about long-term use,
and uncertainty that they will yield significant weight loss.
In purely financial terms, the drugs cost more than $3 a
day on average (Duenwald, 2004). In each of the clinical trials,
use of medication was accompanied by an expensive regime
of behavioral therapies, including counseling, nutritional
education, fitness advising, and monitoring. As journalist Greg
Critser (2003) noted in his book Fat Land, use of weight-loss
drugs is unlikely to have an effect without the proper “support
system”—one that includes doctors, facilities, time, and
money (p. 3). For some, this level of care is prohibitively
expensive.
A third complication is that the studies focused on
adolescents aged 12-16, but obesity can begin at a much younger
age. Little data exist to establish the safety or efficacy of
medication for treating very young children.
While the scientific data on the concrete effects of these
medications in children remain somewhat unclear, medication
is not the only avenue for addressing the crisis. Both medical
experts and policymakers recognize that solutions might come
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Brackets indicate
a word not in the
original source.
A quotation longer
than 40 words is
indented without
quotation marks.
The writer interprets the evidence;
she doesn’t just
report it.
The tone of the
conclusion is
objective.
Obesity in Children 10
not only from a laboratory but also from policy, education, and
advocacy. Indeed, a handbook designed to educate doctors on
obesity recommended a notably nonmedical course of action,
calling for “major changes in some aspects of western culture”
(Hoppin & Taveras, 2004, Conclusion section, para. 1). Cultural
change may not be the typical realm of medical professionals,
but the handbook urged doctors to be proactive and “focus
[their] energy on public policies and interventions” (Conclusion
section, para. 1).
The solutions proposed by a number of advocacy groups
underscore this interest in political and cultural change. A report
by the Henry 3. Kaiser Family Foundation (2004) outlined trends
that may have contributed to the childhood obesity crisis,
including food advertising for children as well as
a reduction in physical education classes and after-school
athletic programs, an increase in the availability of sodas
and snacks in public schools, the growth in the number of
fast-food outlets . . . , and the increasing number of
highly processed high-calorie and high-fat grocery
products. (p. 1)
Addressing each of these areas requires more than a doctor
armed with a prescription pad; it requires a broad mobilization
not just of doctors and concerned parents but of educators,
food industry executives, advertisers, and media
representatives.
The barrage of possible approaches to combating childhood
obesity—from scientific research to political lobbying—
indicates both the severity and the complexity of the problem.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Obesity in Children 11
While none of the medications currently available is a miracle
drug for curing the nation’s nine million obese children, research
has illuminated some of the underlying factors that affect
obesity and has shown the need for a comprehensive approach
to the problem that includes behavioral, medical, social, and
political change.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
List of references
begins on a new
page. Heading is
centered.
List is alphabetized by authors’
last names. All
authors’ names
are inverted.
The first line of
an entry is at
the left margin;
subsequent
lines indent 1⁄2”.
Double-spacing is
used throughout.
Obesity in Children 12
References
Berkowitz, R. I., Wadden, T. A., Tershakovec, A. M., & Cronquist,
J. L. (2003). Behavior therapy and sibutramine for the
treatment of adolescent obesity. Journal of the American
Medical Association, 289, 1805-1812.
Carmona, R. H. (2004, March 2). The growing epidemic of
childhood obesity. Testimony before the Subcommittee on
Competition, Foreign Commerce, and Infrastructure of
the U.S. Senate Committee on Commerce, Science, and
Transportation. Retrieved from http://www.hhs.gov/asl
/testify/t040302. html
Critser, G. (2003). Fat land. Boston, MA: Houghton Mifflin.
Duenwald, M. (2004, January 6). Slim pickings: Looking
beyond ephedra. The New York Times, p. F1. Retrieved from
http://nytimes.com/
Henry J. Kaiser Family Foundation. (2004, February). The role
of media in childhood obesity. Retrieved from http://www
.kff.org/entmedia/7030.cfm
Hilts, P. J. (2002, March 20). Petition asks for removal of diet
drug from market. The New York Times, p. A26. Retrieved
from http://nytimes.com/
Hoppin, A. G., & Taveras, E. M. (2004, June 25). Assessment
and management of childhood and adolescent obesity.
Clinical Update. Retrieved from http://www.medscape
.com/viewarticle/481633
McDuffie, J. R., Calis, K. A., Uwaifo, G. I., Sebring, N. G.,
Fallon, E. M., Hubbard, V. S., & Yanovski, J. A. (2002).
Three month tolerability of orlistat in adolescents with
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006 – Write a paper; Professional research paper writing service – Best essay writers).
Obesity in Children 13
obesity-related comorbid conditions. Obesity Research,
10, 642-650.
Roche Laboratories. (2003, December). Xenical (orlistat)
capsules: Complete product information. Retrieved from
http://www.rocheusa.com/products/xenical/pi.pdf
Yanovski, S. Z., & Yanovski, J. A. (2002). Drug therapy: Obesity.
The New England Journal of Medicine, 346, 591-602.

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