Science class activities for year 10 and years 12-13 - 1 -

STUDENT WORK DOCUMENT

Is our diet healthy?

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Recommended for year 10 and years 12 – 13

Is our diet healthy?

Is your diet complete, varied and well-balanced? Why have cases of being overweight and obesity increased so drastically in developed countries? How is

science contributing to the study of these diseases?

Find out more, form an opinion, research and share it!

Obesity affects more and more people around the world every day. Concerned about the threat this poses for health in the long term, doctors and scientists are trying to understand why people develop obesity in order to design prevention strategies and treatments. In this classroom activities guide, we invite you to find out more about this disease.

Diet is one of the key factors that determines the appearance of obesity, along with others, some of which you will know in this document. We invite you to investigate whether your diet is healthy, and to find out how healthy the diets of your class and schoolmates' families are.

To carry out this research, which will involve direct communication with families, you will need information regarding both scientific and ethical aspects. So let us invite you to go through this series of activities on a healthy diet, obesity and associated illnesses, prevention, existing treatments and on how food is digested.

If you are year 12 or 13 students, we will also look more into different aspects of metabolism, genetics and immunology in order to follow the steps researchers use to investigate obesity, understand the body's mechanisms so as to design treatments or, even better, to prevent the disease.

Once you finish your investigation, we would like you to share your results on the Xplore Health blog so that the community and the other families can make use of it.

Welcome to the world of obesity research!

Science class activities for year 10 and years 12-13 - 2 -

A. Do you think that food is the only factor affecting the development of obesity? (year 10 version)

1. Organise yourselves into groups of four (initial work groups).

2. Note down individually what factors you think contribute to the development of obesity. Put together all of your ideas as a group and then in the class as a whole. Finally put together a comprehensive list of all of the factors you have mentioned.

3. Now watch the video entitled Obesity, a health problem. Note down individually the ideas you think are most important and the things you do not fully understand in a table. NB: we recommend watching the video at least three times.

Most important ideas I do not really understand...

4. In your initial work groups, compare which ideas you thought were most important in the video and then try to come up with a summary of the things you did not fully understand. Choose a spokesperson in each group and write down all of the ideas being suggested on the board. Try to clear up anything that remains unclear with the help of your classmates and teacher.

5. If you still need to, complete the list of risk factors that you started in activity 2 of this section. Also, note down in the following table which illnesses are related to obesity and the amount of people affected by these illnesses in different regions of the planet.

Illnesses associated with obesity Amount of people affected by obesity

6. Once more in your groups, collate the information and complete your lists of factors and tables. Finally make one large group and summarise all the ideas you have written down. If there are any doubts, try to solve them as a group and then complete the table and make a definitive version.

7. At the start of the video Obesity, a health problem, we set you a couple of dilemmas: hamburger or salad? fizzy drink or glass of water? apple or a biscuit? But is it really a question of having to choose one or the other? Discuss this point in your initial work groups.

8. The Body Mass Index (BMI) is an index that relates the body's weight with the height. It is an indicator, which is used to assess the risks associated with being overweight or underweight. Using this link, calculate the body mass index of and adult who is 1.72 m tall and weighs 85 kg. Is this person's weight normal? Why? What would you recommend to this person?

Science class activities for year 10 and years 12-13 - 3 -

A. Do you think that food is the only factor affecting the development of obesity? (year 12-13 version)

A1. Let us talk about metabolismhttps://www.xplorehealth.eu/en/media/shrink-belly-fat

1. In this game, you are asked to help someone with insulin resistance get glucose into their cells. Before playing, however, we would like you to make a presentation on the 6 factors involved in the game. Organise yourselves into groups of 3 or 6, find out all the necessary information and then present your “character” (one of the six factors) to the rest of the group. Here are a few ideas that might help you when preparing your presentation to make sure it's right:

Glucose: you will need to explain where it can come from (from digesting food or gluconeogenesis) and its role in cellular catabolism. Do not forget to mention how the liver is involved!

Insulin: you will need to explain where it comes from, its relation to glucose and its favourite cells: muscular, heart and adipose tissue.

Science class activities for year 10 and years 12-13 - 4 -

Adipocyte: you will need to explain how fat is stored in white fat cells. You will also need to explain the difference between white and brown fat cells.

Receptor: you will need to explain its biochemical nature and dual function. Glucose transporter: you will need to explain its relation to insulin and

muscle, cardiac and adipose cells. Concentrate on its exclusive function! Skeletal muscle cells: you will need to highlight their dual function (aerobic

or anaerobic metabolism, depending on the circumstances).

2. Once everyone's role is clear, develop a kind of script and act out a scene that we will call Insulin resistance.

3. Now have a go at playing the game - we are sure you will be able to help the patient. If you want, you can develop another short script based on the game itself.

A2. Genetics and obesity. Epigenetic mechanisms.

The video Early life origins of obesity talks about the interaction between genes and the environment in the case of people suffering from obesity and type 2 diabetes.

4. Organise all of the information you can gather about the GIFTS project:

Aim

Population studied

Phases of the study

Different expressions of the same gene

Relationship between a healthy lifestyle and the expression of these genes

5. Back in 1953, Conrad Hal Waddington defined the term epigenome to describe all of the evolution processes transforming a genotype into a phenotype. Epigenetics is the science involved in studying them. In a way, DNA could be described as being the script for making all different films. In fact, the life of one very famous actress from the second half of the last century, Audrey Hepburn, is related to one of the very first epigenetic studies: the Dutch famine of 1944 (the “Hunger winter”). Find out more information about exactly what happened and how the children who suffered from malnutrition that winter went on to develop other diseases (including the actress).

Science class activities for year 10 and years 12-13 - 5 -

6. We now suggest you read some summaries (abstracts) of three scientific articles published in Nature. First, fill out the details in the table and then discuss in groups the different epigenetic mechanisms described in the articles.

http://www.nature.com/news/fearful-memories-haunt-mouse-descendants-1.14272

http://www.nature.com/news/new-contender-for-fat-gene-found-1.14863

Genes involved

Modifications of the phenotype

Structural changes to chromatin

Changes to the mRNA (splicing)

Changes to the resultant polypeptide

A3. And the immune system?

8. Read the introduction to the protocol for this Xplore Health Experiment Workshop and describe the role the immune system cells play in the development of atherosclerosis.

9. The following articles describe the relationship between obesity and inflammatory processes:

https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/obesity-inflammation-and-the-immune-system/BBA951027B413AEE76E3DA11A81173F1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507106/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777665/

a) Which cells are involved in the processes described?

b) What are the substances involved in these inflammatory processes?

c) What does knowing about these processes have in relation to preventing these diseases?

A4. Conclusion:

10. Write a report explaining the importance that a person's metabolism, genetics and immune system has on their developing obesity. The aim is to provide information for the entire school community on its web page.

Science class activities for year 10 and years 12-13 - 6 -

B. Preventing obesity

As you have now seen, more and more people are affected by overweight and obesity. How do you think we can prevent obesity? How do you think scientists answer these questions?

1. In groups, describe the research project HELENA that is introduced in the Xplore Health video entitled Promoting healthy lifestyles. Use the following guide to help you describe the research accurately:

a. Introduction (brief summary of what the experiment aims to achieve);

b. Working Hypothesis (to be formulated as an “if... then...” phrase);

c. Procedure (explain what the scientists are doing in each step and why);

d. An analysis of the results obtained as part of this experiment;

e. Conclusions (relate them to your initial aim).

2. Based on the conclusions from the HELENA project, the University of Zaragoza developed another project called TOYBOX. What was the aim of the project? For what reason did the TOYBOX project concentrate on children of such young ages (4-6 years old)?

3. Now we would like to invite you to become researchers. We would like you to design a study to investigate the prevalence of overweight and obesity in the pupils at your school. To carry out this research project, we suggest carrying out the following steps:

a. Design a sample questionnaire to collect data you consider relevant to the study. Share your questionnaire with the other groups and come up with one single model, which can be used to summarise all the data you collect. It is important you take into account the confidentiality of the data collected.

b. As a group, decide how many people in your school you want to survey. Should you ask everyone in the whole school, or just a cross-section? Why?

c. Agree on how you are going to analyse the results for each of the questions in the survey: percentages, graphs, etc.

4. Finalise the questionnaire, hand it out, collect the answers and analyse the results. Put together a poster summarising the main conclusions you can draw from the study. Distribute the poster using your school's web page, noticeboards, etc. Remember the aim is to raise awareness among the school community of the prevalence of obesity in your school.

Science class activities for year 10 and years 12-13 - 7 -

C. How can we investigate if our diet is healthy?

1. What characteristics must a healthy diet have? Why do we say that a healthy diet needs to be balanced, varied and complete? Discuss the topic with the others in the class.

2. Find the Healthy Eating Plate of Harvard on the internet and then describe the proportions of different food types that you should have in a healthy meal.

3. In your initial work groups, put together some ideas as to how you think you can research whether our diet is healthy or not. Then jot down a few starting ideas about how this study could be carried out.

4. What variables need to be fixed so that we are all investigating according to the same criteria and can therefore compare the data afterwards and come to conclusions as a whole group? Come to an agreement with the rest of the class.

5. Note down individually all the food types and quantities you eat in each daily meal and compare them with the Healthy Eating Plate. Discuss them with you work group. Do you follow the healthy proportions of the Healthy Eating Plate in your meal?

6. Determine the nutritional value of your daily diet. To calculate the quantities, use the guide to approximate measures that we provide you in appendix 1. You can use the nutrition table for different foods you can find on the internet such as the one provided by the Spanish Food Composition Database or the American National Nutrient Database.

For the list of foods you have in your daily diet, note down the amounts of calories, total lipids, saturated fatty acids, carbohydrates, proteins, fibre and salt they contain in a table like the one below:

Food

type

Quantity Energetic value (Kcal)

Carbohydrates Proteins Total lipids

saturated fatty acids

Fibre Salt

As you can see in this link from the WHO, in a healthy diet, lipids should not exceed 30% of total calorie intake and intake of saturated fatty acids should represent less than 10% of the total. On the other hand, the EFSA (European Food Safety Authority) says that you should eat about 25g of fibre a day and the carbohydrate intake should be between 45-60% of the total. Are these premises met in your case?

Science class activities for year 10 and years 12-13 - 8 -

7. Compare your results against the class average and then discuss them in your different work groups. Does each member of the group get the right amount of each type of food? And as a whole?

8. How do you think you can improve your diets? In the different work groups, come up with an example of a balanced diet for one day.

9. Do you like eating at fast food restaurants? Take a look at the following information on the fat content of fast food menus at this link and then watch this video. Afterwards, organise a short discussion on what you find out.

Science class activities for year 10 and years 12-13 - 9 -

D. Treating obesity (year 10 version)

This multimedia tool contains a game for reducing belly fat. Before playing the game, there is an introduction which explains how carbohydrates are formed and how we digest them. Watch the whole introduction and then answer the following questions in your work groups:

1. What do carbohydrates and fats have in common, and what are the differences between them?

2. What foods contain glucose?

3. Which organs are responsible for breaking down the glucose? And which organs absorb it?

4. This multimedia tool doesn't refer to the part of digestion which takes place inside the mouth. What role do you think this part of our body plays in digesting glucose?

Science class activities for year 10 and years 12-13 - 10 -

5. Do you think that all the glucose needed by our body comes from the digestion of carbohydrates?

6. In your own words, describe the role insulin plays in the process. Where is it produced? How does it work?

7. What is the relationship between adipocytes and body fat?

8. What does type 2 diabetes consist of? In what way do obesity and belly fat contribute to the development of this disease?

9. Now play the game and help the patient reduce their belly fat. Take a screenshot of your final score. Did you manage to help the patient? Why?

10. Now play the game “Can you carry out surgery to treat obesity?” and discover other methods for reducing obesity.

11. What are the advantages and disadvantages of gastric bypass surgery for reducing obesity? Why do you think that this type of surgery is only used for the most serious cases of obesity?

12. Which parts of the digestive tract are involved in the surgery?

13. What happens to the duodenum in the first part of the surgery? What problems could this cause to the patient?

14. What is achieved during the second part of the surgery?

15. Up till now we've been looking at the digestion of glucose. What other nutrients providing energy can be found in food? Back in your initial work groups, put

Science class activities for year 10 and years 12-13 - 11 -

together a presentation with slides on the digestive process for one of these nutrients and share your findings with the rest of the class.

D. Treating obesity (year 12-13 version)

Obesity increases the risk of hypertension, but it also increases the risk of developing diseases such as arteriosclerosis, which can cause heart attacks or strokes. It can also lead to diabetes, as you saw earlier. In working groups, you will research what genetic engineering is and how a transgenic organism is made in the context of a line of research on this disease. You will find it helpful to use an experimental protocol which is being carried out in a line of research to develop a drug against arteriosclerosis and which you can find at the following Xplore Health link .

1. Prepare a presentation that answers the following questions: What does this disease consist of? What is the study object of the line of research mentioned in the protocol? What is a therapeutic target?

To study the protein described in the protocol, the researchers need to produce large amounts of it in the laboratory. To do this, they use a genetic-engineering technique called bacterial transformation. Using this technique, they transfer DNA from an organism to a bacteria so that it produces large amounts of DNA, which they then put into other types of cells to produce the protein (which is a possible therapeutic target).

2. With the help of diagrams, include in your presentation an explanation of what genetic engineering is and the different stages of this process of bacterial transformation.

3. Now carry out a bacterial transformation in the Xplore Health virtual lab in order to obtain a drug target. Here is the link. Make screenshots of the different stages of this process and include them in your presentation. Describe, too, the objectives of the scientists when they carry out this process.

Note: we also recommend that you carry out the research project against arteriosclerosis that you'll find at this link . When you have finished, prepare a practical test report (see Appendix 1 of this document).

Science class activities for year 10 and years 12-13 - 12 -

E. Discussing the ethical, legal and social aspects related to obesity.

1. Watch the video entitled Obesity: ethical issues that you can find on the Xplore Health page. Discuss the following questions with your classmates:

a. Why is obesity much more of a problem than just an excess of weight or body fat?

b. How can industry and institutions help reduce levels of overweight and obesity?

2. To prepare yourself for the debate, read the first 8 pages of this document on your own.

3. Organise debates in groups of 6. Present the results obtained in each group and compare them to the rest; try to come to a consensus with regards to the “Agree” and “Disagree” card you have used. The process should be as follows:

a. 5 min: presentation.

b. 25 min: debate game in each group.

c. 20 min: each group presents the results of their debate to the rest of the class.

d. 10 min: debate in class to try to reach a consensus.

Once you've finished the debate, put together an article explaining your conclusions and publish it on the Xplore Health blog.

Science class activities for year 10 and years 12-13 - 13 -

F. Do your schoolmates' families have a healthy diet?

1. In small groups, design a questionnaire template. Afterwards, compare your questionnaire with the other groups and decide which questions you want to include. (NB: remember the steps you followed to design the questionnaire in Section B of this classroom activities guide).

2. Design a questionnaire using the free tools on the internet.

3. Write a letter to be sent to all of the families in the school and speak to the school administration to get their support and in order to plan how to carry out this campaign to provide information. Remember to set a deadline for when the questionnaire should be returned.

4. Afterwards, collate the data and interpret the findings in groups. What conclusions can you draw from the data?

5. Once you have completed your research project, write a new report and share the results with the families involved and the Xplore Health blog. Your aim should be to concentrate on raising awareness in the educational community on the importance of taking preventive measures against overweight and obesity so as to avoid the associated issues.

Science class activities for year 10 and years 12-13 - 14 -

Appendix 1. Guide to approximate measures

Amount of food Equivalence

One soup spoon 20 ml

One spoonful of sugar or rice 20 g

One dessert teaspoonful 10 ml or 10 g

One glass of milk 250 ml

One glass 200 ml

One coffee or small cup 70 ml

Serving of meat 225 g

Slice of pork 40 g

¼ chicken 200 g

Serving of fish 250 g

Sausage 70 g

Slice of bread 15 g

Potato 120 g

Apple and other pieces of fruit 150 g

Egg 65 g

Science class activities for year 10 and years 12-13 - 15 -

TABLE OF CONTENTS

Level Areas Blocks Content Class hours

Year 10 Biology and geology

Health and disease

The function of nutrition in humans

A. Do you think that food is the only factor affecting the development of obesity? (year 10 version)B. Preventing obesityC. How can we investigate if our diet is healthy?D. Treating obesityE. Discussing the ethical, legal and social aspects related to obesityF. Do your schoolmates' families have a healthy diet?

1 hour

3 hour2 hour2 hour1 hour

2 hour

Years 12-13

Science Health and medical investigation

A. Do you think that food is the only factor affecting the development of obesity? (year 10 version)B. Preventing obesityC. How can we investigate if our diet is healthy?D. Treating obesity (year 10 version)E. Discussing the ethical, legal and social aspects related to obesityF. Do your schoolmates' families have a healthy diet?

1 hour

3 hour2 hour2 hour1 hour

2 hour

Year 12/13 biology

BiomoleculesMetabolism

Regulation of genetic expression

(epigenetics)Genetic engineering

Immunology

A. Do you think that food is the only factor affecting the development of obesity? (year 12-13 version)B. Preventing obesityC. How can we investigate if our diet is healthy?D. Treating obesity (year 12-13 version)E. Discussing the ethical, legal and social aspects related to obesityF. Do your schoolmates' families have a healthy diet?

3 hour

3 hour2 hour1 hour1 hour

2 hour

Science class activities for year 10 and years 12-13 - 16 -

Science class activities for year 10 and years 12-13 - 17 -

AUTHORS OF THIS DOCUMENT*: Albert Poveda (INS Apel•les Mestres), Montse Colilles (INS Can Puig de Sant Pere de Ribes), Lluís Pagès (biology and geology secondary school teacher), Rosina Malagrida (Xplore Health coordinator) and Josep Carreras* Part of the Tandem project of the Catalunya-La Pedrera Foundation

EXPERT SUPERVISION: Cristina Andrés

COORDINATION:Rosina Malagrida

DATE: January 09th 2019

DEVELOPED BY: