The experiment of a new pedagogical model

The initiative of the creation of this course was centred on two basic ideas:

1. To raise the academic level of preparation in an emerging area in terms of the health of the population.

2. To structure theoretical teaching and its practical derivations in an interdisciplinary manner, transversal to areas that are not usually interrelated.

Given the evolution and genetic selection of the human being, one may note that what was beneficial in an evolutionist perspective – the polygenic complex of metabolic “good use” and its phenotype, insulin resistance – has become transformed into a risk factor at a time of caloric abundance and sedentary life.

Obesity is a diabetes risk factor, and the two pathologies become direct risk factors of cardiovascular disease. And, at the time of a prolonging of life expectancy, there is the paradoxical appearing of an increase in the risk of illness and early deaths when compared to that possible prolonging given the new human conditions in the developed countries. And in relation to those which are “developing”, there is no way out, using an expression by the World Health organization – when they come out of famine they go directly into obesity, diabetes and cardiovascular risk.

This new circumstance of human pathology is without doubt thrilling in the point of view of its – genetic, biochemical and social – study. On the other hand, it fits into the avoidable situations or those which are at least partly controllable because they depend on human behaviour – dietary habits and physical activity.

Parallel to the emerging of this predominance of illnesses of the metabolism, there are the pathologies of dietary behaviour that can be correlated to them. However, alongside true illnesses of dietary behaviour – anorexia nervosa, bulimia nervosa, compulsion – restriction, compulsive disturbance – there is the daily struggle against obesity that always consists of the right dosage or differential between what one ingests and what one spends, in a world surrounded by an appeal to calorie intake and sedentary lifestyle, both anchored in our archaic roots. Here it is a matter of cultural, social, economic and political questions.

Interdisciplinarity

In order to deal with this area a new model of theoretical learning has been considered. We are living in a time when once again interdisciplinarity is needed. It is apparent that the new texts of philosophy or social sciences use, or even cannot do without, the new concepts of biochemistry, physics and biology. In the same manner biology, and particularly human biology, cannot be a compartment closed off to the other sciences. The evolutionist perspective is today a new instrument for understanding human physiology and pathology. Distinguishing the “biological” from the “natural”, from the “cultural” is pure mechanicist academic work if there is not an effort to integrate and accept complex thought, because reality is complex. And if scientific thought reaches some levels of consolidation of (probably transitory) concept, many others remain as open questions, which the several scientific areas can only reply to in a fractioned form.

For this reason we thought that in this field of diseases of the metabolism and dietary behaviour one could go from the most micro aspect of human perception – biochemistry, genetics – to the most macro and most collective – sociology.

This was the decision of the Scientific Committee of the Course, made up of:

Professor Brás Nogueira

Professor Constantino Sakellarides

Professor Daniel Sampaio

Professor Henrique Bicha Castelo

Professor Isabel do Carmo

Professor João Martins

Professor Manuel Bicho

The areas defined were:

1. Determinants and Consequences of Metabolic Illnesses
2. Human Diet
3. Epidemiology and Evaluation of Obesity
4. General Biochemistry
5. Applied Biochemistry
6. Genetics
7. Diabetes and Metabolic Syndrome
8. Illnesses of Alimentary Behaviour
9. Cardiometabolic Risk in Clinical Practice and Modifications in Lifestyle
10. Anatomophysiology and Surgery.

The diversity of these areas thus does not follow the tradition scheme of gradual deepening of one single subject, but risks granting a general panorama, although at a high level, of different but connectable issues.

After the advanced theoretical course, each student will choose the subject to be studied more deeply, yet using the instruments made available to them through the other subjects. This “renaissance” view is a challenge that may arouse enthusiasm if each person understands that what they are learning is not something one can classify as “general knowledge”, but an opening of doors and windows without which human knowledge, even specialised knowledge, cannot progress.

Bibliography

– Carmo I, dos Santos O, Camolas J, Vieira J, Carreira M, Reis, L, Myatt J,
Galvão –Teles A. Overweight and Obesity in Portugal: national prevalence in 2003 – 2005. Obesity Rev2008; 9: 11-19.

– Carvalho H. Análise multivariada de dados qualitativos – utilização da análise, de correspondência múltiplas com o SPSS, Edições Silabo, Manchester, 2008.

– French SA, Story M, Jeffery RW, Environmental influences on eating and physical activity. Ann Rev Pub Health 2001; 22:309- 35.

– Garrow JS and Webster J. Quetelet’s index (w/H2) as a measure of fatness. Int Journal of Obesity 1985; 9: 147-153.

– Hodge AM and Zimmet P Z. The epidemiology of obesity. Bailliere’s clinical Endocrinology and Metabolism, 1994, 8(nº 3): 577 – 599.

– Lichtenstein AH et al., Diet and lifestyle – le recommendations revision 2006: a scientific statement from the American Heart Association Nutrition committee. Circulation, 2006; 114: 82 – 96.

– Lobstein T and Frehnt ML. Prevalence of overweight among children in Europe. Obesity Rev 2003; 4: 195 – 200.

– Marmot M., Health in an Unequal World, Royal College of Physicians of London, 2006.

– Ogden C et al. Prevalence of overweight and obesity in the United States, 1999-2004 J AMA, 2006, 295 : 1549 – 1555.

– OMS. Obesity. Preventing and managing the global epidemic, Geneva, 1997.

– Padez C et al. Prevalence of Overweight and obesity in 7 – 9 year old Portuguese children: trends in body mass index from 1970 – 2002.

– Am. J Hum Biol 2004; 16: 670 – 678.

– Resmicowk. Workshop entrevista motivacional, Faculdade de Motricidade Humana, 2007.

– Silva, M. et al. A randomized controlled trial to evaluate self–determination theory for exercise adherence and weight control: rationale and intervention description. BMC Public health 2008; 8: 1– 13.

-Teixeira P et al. A actividade física e o exercicio no tratamento da Obesidade. Endocr Metab e Nutr 2006; 15(nº 1): 1-15.

– Tremblay A and Doucet E. Obesity: a disease or a biological adaptation? Obes. Rev 2000; 1: 27 -35.

– Vilaverde- Cabral e col. Doença e Saúde em Portugal, ed ICS, 2006.

– World Cancer Research Fund, Am Institute for Cancer Research, Instituto Nacional de Cancer, Alimentos, Nutrição, Actividade Física e Prevenção de Câncer: uma perspectiva global, Rio de Janeiro, INCA, 2007.

– Zimmet P, Dowse G, Find C., The epidemiology and natural history of NIDM – lessons from the South Pacific. Diabetes/ Metabolism rev 1990; 6 (nº 2): 91 – 124.

Recommended Internet Pages
Direcção Geral de Saúde – www.dgs.pt
National Institutes of Health – www.nih.gov
Center for Disease Control – www.cdc.gov
U.S. Department of Agriculture, Food Composition Tables – www.usda.gov
American Dietetic Association – www.adaf.org
Institute of Medicine, Dietary Reference Intakes – www.iom.edu
Food and Drug Administration – www.fda.gov

Isabel do Carmo
isabel.carmo@hsm.min-saude.pt
secretariadoheid@gmail.com