Experience

Publications

• Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program

  Hartley & Marks

• Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program

  Hartley & Marks

• Dietary Assessment of Adolescents Undergoing Laparoscopic Roux-en-Y Gastric Gypass Surgery: Macro- and Micronutrient, Fiber and Supplement Intake

  Surgery for Obesity and Related Disorders

  BACKGROUND: Extremely obese adolescents are increasingly undergoing bariatric procedures, which restrict dietary intake. However, as yet, no data are available describing the change in caloric density or composition of the adolescent bariatric patient's diet pre- and postoperatively. Our objective was to assess the 1-year change in the dietary composition of adolescents undergoing bariatric surgery at a tertiary care children's hospital. METHODS: A total of 27 subjects (67% female, 77% white, age 16.7 ± 1.4 yr, baseline body mass index 60.1 ± 14.1 kg/m(2)) were prospectively enrolled into an observational cohort study 1 month before undergoing laparoscopic Roux-en-Y gastric bypass from August 2005 to March 2008. The 3-day dietary intake was recorded at baseline (n = 24) and 2 weeks (n = 16), 3 months (n = 11), and 1 year (n = 9) postoperatively. The dietary record data were verified by structured interview and compared with the Dietary Reference Intake values for ages 14-18 years. RESULTS: By 1 year after surgery, the mean caloric intake, adjusted for body mass index was 1015 ± 182 kcal/d, a 35% reduction from baseline. The proportion of fat, protein, and carbohydrate intake did not differ from baseline. However, the protein intake was lower than recommended postoperatively. The calcium and fiber intake was also persistently lower than recommended. Calcium and vitamin B(12) supplementation increased the likelihood of meeting the daily minimal recommendations (P ≤ .02). CONCLUSION: At 1 year after Roux-en-Y gastric bypass, the adolescents' caloric intake remained restricted, with satisfactory macronutrient composition but a lower than desirable intake of calcium, fiber, and protein. Comment on: Dietary assessment of adolescents undergoing laparoscopic Roux-en-Y gastric bypass surgery: macro- and micronutrient, fiber and supplement intake.

• Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program

  Hartley & Marks

• Dietary Assessment of Adolescents Undergoing Laparoscopic Roux-en-Y Gastric Gypass Surgery: Macro- and Micronutrient, Fiber and Supplement Intake

  Surgery for Obesity and Related Disorders

  BACKGROUND: Extremely obese adolescents are increasingly undergoing bariatric procedures, which restrict dietary intake. However, as yet, no data are available describing the change in caloric density or composition of the adolescent bariatric patient's diet pre- and postoperatively. Our objective was to assess the 1-year change in the dietary composition of adolescents undergoing bariatric surgery at a tertiary care children's hospital. METHODS: A total of 27 subjects (67% female, 77% white, age 16.7 ± 1.4 yr, baseline body mass index 60.1 ± 14.1 kg/m(2)) were prospectively enrolled into an observational cohort study 1 month before undergoing laparoscopic Roux-en-Y gastric bypass from August 2005 to March 2008. The 3-day dietary intake was recorded at baseline (n = 24) and 2 weeks (n = 16), 3 months (n = 11), and 1 year (n = 9) postoperatively. The dietary record data were verified by structured interview and compared with the Dietary Reference Intake values for ages 14-18 years. RESULTS: By 1 year after surgery, the mean caloric intake, adjusted for body mass index was 1015 ± 182 kcal/d, a 35% reduction from baseline. The proportion of fat, protein, and carbohydrate intake did not differ from baseline. However, the protein intake was lower than recommended postoperatively. The calcium and fiber intake was also persistently lower than recommended. Calcium and vitamin B(12) supplementation increased the likelihood of meeting the daily minimal recommendations (P ≤ .02). CONCLUSION: At 1 year after Roux-en-Y gastric bypass, the adolescents' caloric intake remained restricted, with satisfactory macronutrient composition but a lower than desirable intake of calcium, fiber, and protein. Comment on: Dietary assessment of adolescents undergoing laparoscopic Roux-en-Y gastric bypass surgery: macro- and micronutrient, fiber and supplement intake.

• physical activity monitoring in extremely obese adolescents from the teen-laboratories study.

  journal of physical activity & health

  the accuracy of physical activity (pa) monitors to discriminate between pa, sedentary behavior, and nonwear in extremely obese (eo) adolescents is unknown.

• Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program

  Hartley & Marks

• Dietary Assessment of Adolescents Undergoing Laparoscopic Roux-en-Y Gastric Gypass Surgery: Macro- and Micronutrient, Fiber and Supplement Intake

  Surgery for Obesity and Related Disorders

  BACKGROUND: Extremely obese adolescents are increasingly undergoing bariatric procedures, which restrict dietary intake. However, as yet, no data are available describing the change in caloric density or composition of the adolescent bariatric patient's diet pre- and postoperatively. Our objective was to assess the 1-year change in the dietary composition of adolescents undergoing bariatric surgery at a tertiary care children's hospital. METHODS: A total of 27 subjects (67% female, 77% white, age 16.7 ± 1.4 yr, baseline body mass index 60.1 ± 14.1 kg/m(2)) were prospectively enrolled into an observational cohort study 1 month before undergoing laparoscopic Roux-en-Y gastric bypass from August 2005 to March 2008. The 3-day dietary intake was recorded at baseline (n = 24) and 2 weeks (n = 16), 3 months (n = 11), and 1 year (n = 9) postoperatively. The dietary record data were verified by structured interview and compared with the Dietary Reference Intake values for ages 14-18 years. RESULTS: By 1 year after surgery, the mean caloric intake, adjusted for body mass index was 1015 ± 182 kcal/d, a 35% reduction from baseline. The proportion of fat, protein, and carbohydrate intake did not differ from baseline. However, the protein intake was lower than recommended postoperatively. The calcium and fiber intake was also persistently lower than recommended. Calcium and vitamin B(12) supplementation increased the likelihood of meeting the daily minimal recommendations (P ≤ .02). CONCLUSION: At 1 year after Roux-en-Y gastric bypass, the adolescents' caloric intake remained restricted, with satisfactory macronutrient composition but a lower than desirable intake of calcium, fiber, and protein. Comment on: Dietary assessment of adolescents undergoing laparoscopic Roux-en-Y gastric bypass surgery: macro- and micronutrient, fiber and supplement intake.

• physical activity monitoring in extremely obese adolescents from the teen-laboratories study.

  journal of physical activity & health

  the accuracy of physical activity (pa) monitors to discriminate between pa, sedentary behavior, and nonwear in extremely obese (eo) adolescents is unknown.

• Uterine Blood Blow during Supine Rest and Exercise after 28 Weeks of Gestation”.

  British Journal of Obstetrics and Gynecology

  Abstract OBJECTIVE: To test the null hypothesis that, after 28 weeks of gestation, uterine blood flow during supine rest and supine exercise is no different than uterine blood flow at left-lateral rest. DESIGN: In vivo experimental study in pregnant women. SETTING: Department of Obstetrics, MetroHealth Medical Center, Cleveland, OH, USA. POPULATION: Fourteen, physically active, late-pregnant women who continued supine exercise throughout gestation. METHODS: Studies were carried out between 29 and 38 weeks of gestation. Maternal blood pressure, maternal heart rate, and ultrasound estimates of volume blood flow in the right ascending branch of the uterine artery were obtained serially at rest in the left-lateral position, at rest in the supine position, during and immediately after 10 minutes of supine exercise, and again at rest in the left-lateral position. Exercise sessions included alternating 60- to 90-second periods of abdominal crunches and leg exercise at moderate/high intensity (Borg's rating of perceived exertion 14 +/- 1). MAIN OUTCOME MEASURES: Blood pressure, heart rate, and uterine artery volume flow. RESULTS: Data are presented as the mean +/- SD. Maternal heart rate and blood pressure were unchanged at supine rest but increased during supine exercise (heart rate increased from 76 +/- 9 to 98 +/- 12 beats per minute, mean arterial pressure increased from 81 +/- 6 to 102 +/- 12 mmHg). Volume flow fell from 410 +/- 93 to 267 +/- 73 cc/minute after 5 minutes of supine rest and then, during supine exercise, increased to 355 +/- 125 cc/minute. Uterine artery luminal diameter and blood flow correlated directly with tissue weights at birth (r(2) values between 0.32 and 0.59). CONCLUSIONS: In physically active women, uterine blood flow decreases during both supine rest and supine exercise but the decrease in the former is twice that seen in the latter.