Which is More Effective in Treating Obesity?

The third in a series of articles encompassing healthy weight loss, nursing and insight into obesity with an evidence based approach to the physiological, psychological and pharmacological implications of this condition. Nurses General Nursing Article

  1. Which do you think is better?

    • 11
      Diet and Exercise
    • 1
      Surgical Intervention
    • 0
      Why on earth are you asking me this in the middle of Holiday Season??!
    • 2
      *Nom Nom* (Gaping mouth full of some sort of contraband food item) what?

14 members have participated

Which is More Effective in Treating Obesity?

Holiday season is upon us. The struggle is real. I'm still fighting the good old battle of weight loss and at 300 to 305 and my body may be hanging out in plateau island again. It's time to reevaluate my eating habits, drink more water, get more sleep and see when the scale will budge.

So here I am and despite the insanity... and...

I finished my evidence based paper.

It got a good grade and I have corrected it according to my Professors recommendations. No matter what I have done...It's not what I want it to be.

I'll explain.

Evidence based research is best when you have data points that encompass and answer your question, or what it is you seek.

You form a PICOT question and you search for peer reviewed journals preferably with a shelf life of no more than three to five years.

A PICOT question is

  1. Patient population
  2. Intervention or issue of interest
  3. Comparison intervention or group
  4. Outcome
  5. Time frame

My Original one was:

  1. (P) For patients with obesity (BMI > 30)
  2. (I) Does nutritional education , diet and exercise
  3. © Compared to nutritional education and endoscopic bariatric surgical intervention
  4. (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 5 years? 10 Years? 15 Years?

I had the worse time finding research that was peer reviewed and not over 5 years old that followed patients with a BMI of over 30 over 5, 10, 15 years post surgical intervention. I also wanted more solid data on weight loss along with diet and exercise. I don't think anyone has followed a group of people around long after they reached their goal weight. I understand to make a study viable you have to keep in touch with many people over a long period of time. Eventually you loose numbers and people here and there.

What I present to you is what I found within the time constraints of my assignment. I modified my window to 3 years and used the data points at the highest and lowest outcomes. I'm not happy with it because there has to be more evidence for diet and exercise out there with more optimistic numbers.

I want to dig deeper. I want to know more. I need to be more specific in my question also. I need to break it down to women, men, ages. The research had individuals broken down by age, gender, ethnicity, co morbidities. All I wanted was an overall with age, gender and timeline. There will be a revision of this paper sometime in the future but as promised here it is in it's entirety. The APA formatting went to H E Double hockey sticks but that's ok. I'm not encouraging plagiarization. I am merely presenting information. I hope you enjoy it :

*****

Which is More Effective in Treating Obesity?

Nursing Research and Statistics

Which is More Effective in Treating Obesity?

Introduction

Obesity has gripped the world and the battle against it is spread across medical journals, beauty magazines, infomercials and more. Patients are flooded with get quick schemes and lulled by work out routines with gadgets that promise quick unbelievable results. Health care professionals scramble to find alternate means of weight loss that is not only safe but effective for the thousands of people coming to grip with the reality that something must be done.. It was estimated by the Oxford Journal of Medicine &Health that by " 2015, 75% of adults would be overweight or obese, and 41% will be obese" (Yang & Beydoun, 2007). Their estimation was not too far off. In 2014 the CDC concluded 36.5% of adults were obese having a BMI> 30 ("Adult Obesity facts," 2014). So the question is how do we successfully treat obesity and in essence provide the patient with the most effective outcome in the long run? (P) For patients with obesity (BMI > 30) (I) Does nutritional education, diet and exercise © Compared to nutritional education and surgical intervention (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 1-3 years.

Summary of the problem

Obesity and it's many health risks are increasing in prevalence as the years tick by. Patients are looking for ways to lose significant amounts of weight and keep it off. Diet schemes that dehydrate a patient or provide quick and short term weight loss become more of a problem than a solution. Weight loss may trigger hormones that fuel weight to return. According to the New England Journal of Medicine, hunger-related hormones disrupted by dieting and weight loss can remain at altered levels for at least a year"(MacMillan, 2011). The most recommended method for weight loss, particularly in obese patients by physicians is nutritional education, diet and exercise . Surgical intervention requires conventional weight loss before the procedure , counseling, nutritional education and screening to determine if surgery will be the safest option. Generally there is a 3-18 month insurance mandated preoperative dietary weight loss before bariatric surgery (Kim, Rogers, Ballem, & Schirimer, 2016).

Relevance to practice

According to the CDC "The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars" and there were many health risks like certain types of cancer, Type II Diabetes and heart conditions from obesity that became the "leading causes of preventable death"("Adult Obesity facts," 2014). To give patients the correct tools to bring down their weight into a healthy range for their height and age not only improves their quality of life but it impacts the health care system on a fiscal level and physical level. If we could reduce preventable diagnosis by implementing weight loss strategies that work we could possibly increase the length and quality of our patients lives.

Search method

The following studies and articles were used using the online library archive for the University of Texas at El Paso's library website, utilizing Google Scholar and browsing available journals through the American Nurses Association website. Searches were conducted using key words such as weight loss, obesity, diet and exercise, surgical intervention, gastric sleeve, bypass, lap-band ,long term outcome, 5-10-15 years. A total of 4 articles were utilized in this paper. This combined with a lifetime of dieting and consistently dealing dealing with obesity on a personal level have contributed to this paper. The PICOT question has been modified to fit the findings with an outcome window of 1-3 years post weight loss.

Summary of findings

Using all the studies in the chart below the highest start BMI with the percentage of excess weight loss at 1 and three years respectively and the average BMI at these times were utilized for this paper .The timeline was modified for the Kritchevsky study using its end time at 27 months. There were different surgical interventions that used the band or sleeve that are not mentioned. The highest rate was recorded, with the most successful intervention in each study to compare all findings. The BMI scale used is as follows. BMI Obese. Under the Coleman study the BMI average at start was 39 kg/m2. After 1 year post surgical intervention with Roux-en-y gastric bypass there was a 50% reduction in excess weight yielding a BMI of 19.5. After 3 years there was a 46% excess weight loss yielding a BMI of 21.06. Under the Sczepaniak study the starting BMI was 47 Kg/m2 and in 6 months post surgical intervention there was a 50% reduction in overall weight yielding a BMI of 23.5. In one year post surgical intervention there was a loss of 60.2% overall body weight yielding a BMI of 18.70.This method utilized the sleeve gastronomy. Both surgical interventions brought the BMI of individuals in the mean data to normal BMI range as early as 6 months and in the 3 year post marker there was still a maintenance in a normal BMI.

In the Kritchevsky study the starting BMI was 46 K/m2 There are no results at the one year margin . There was an overall goal of 5-10% of overall reduction of body weight. The end result at the latest was a 27 month window (2 years and 3 months) with a total ending BMI of 41.4. The study was a success as it met it's initial goal however it fails to show surpassing data in regards to weight loss with diet and exercise. In the Foster-Schubert study the participants started at a mean BMI of 30.9 Kg/m2 and had a 13.5% decrease in overall weight over one year. Data for 6 months was not available. The resulting BMI would be 26.72 which is still considered overweight but not obese. it also only utilized post menopausal women.

With the lack of viable information and/ or studies supporting normal weight loss not utilizing surgical intervention and their long term outcomes it can only be concluded that the most successful way to reduce BMI and promote overall health in a 1-3 year outcome is surgical intervention.

Implications for practice

It is still highly recommended that before surgical intervention a proper diet and exercise routine be implemented into the routine of an obese patient. Further patient education and monitoring can take place to pinpoint areas that may need reinforcement. Once a percentage of the weight is lost the patient care team can move ahead in planning surgical intervention for a better long term outcome in weight loss for obese patients.

PICO Question : (P) For patients with obesity (BMI > 30) (I) Does nutritional education , diet and exercise © Compared to nutritional education and surgical intervention (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 1-3 years?

Authors, Date and TitlePurposeDesign &
Research
Method		Setting and SampleMeasurements and OutcomesCommentsLevel
Of
Evi-dence
Coleman , K. J., Huang, Y., Hendee, F., Watson, H. L., Casillas, R. A., & Brookey, J. (2014, February 6). Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surgery for Obesity and Related Diseases , 10(), 396-404.To outline patients from 2004 to 2013 who had procedures for weight loss. The object was to present 3 year weight loss outcomes.Patients were passively enrolled into registry with criteria of bariatric procedure for eight loss from Jan1 2004 and actively enrolled in health plan at time of surgery.Setting was all patients who had a bariatric procedure from Jan 2004 to 2013
Sample were Hispanic, Non Hispanic white and non-Hispanic Black participants and three different procedures		Roux-en-Y gastric bypass patients lost more weight than any other procedure in 3 year outcome. Non Hispanic whites had a higher percentage of weight loss than non Hispanic Blacks overall on RYGB.The article broke down individuals by race where I was looking for more of a percentage of body weight loss and maintained over three years to compare to general diet and exercise data in other studiesV
Kritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., & Nicklas, B. J. (2015, February 10). intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials. PlOS ONE.RTC's of weight loss used to clarify results of intentional weight loss on mortalityAbstracts and data was viewed in PUBMED yielding 15 RTC's. The authors used other case studies instead of using their own.Females and Males with a mean age of 52 years old. Follow up times ranged from 18 months to 12.6 years. Mean was 27 months.
Weight loss interventions were all lifestyle based and not surgical. There was a control set of men and women
who was not in a weight loss group.		The weight loss groups experienced 15 percent lower all-cause mortality risk. So losing weight only saved you 15% lower risk of dying sooner.This study focused more on how much longer an individual can survive if they lost weight compared to those that did not however I can use the weight loss data over time to compare to my 3 year individuals with surgical intervention.II
Sczepaniak, J. P., Owens , M. L., Shukla, H., Periegos, J., & Garner , W. (2014, 14 November ). Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy 2008-2011. Obesity Surgery , 25(5), 788-795. Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 28-211 | SpringerLinkTo measure total weight loss after surgical intervention using Gastric bypass and Sleeve GastrectomyBOLD Data was accessed from 2008-2011 for over 200K patients who underwent the two surgical procedure164,247 patients were utilized after removal of errors and missing data. Demographics Female, Male, height, age, weight. Hispanic, white, black, weight at 6 and 12 months.The greatest outcome after a year came from the sleeve gastrectomy patients 60.2% of total body weight loss.This study did not focus on how much physical weight was loss but placed it in total body percentage lost with different surgical procedure over a max of 12 months. If I strain my data from the other two I can answer my study question with a time span of one year by averaging my results from three years and dividing by three. This will not leave me with perfect results but a rough estimate.II
Foster-Schubert, K., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., ... McTiernan, A. (2012, April 14). Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese post-menopausal women. Obesity, 8(). Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women - Foster-Schubert - 212 - Obesity - Wiley Online LibraryTo measure total weight loss after non surgical intervention over 1 yearsPatients completed a questionnaire and were weighed to measure progress.Participants completed a series of questionnaires at their baseline screening visit prior to randomization, including demographic information, medical history, health habits, reproductive and body weight history, diet intakeThe greatest outcome after a year was a 13.5% decrease in BMIThe study focused on post menopausal women but it did show how diet and exercise could be combined to lose weight. The data was weak at best compared to surgical intervention. .I

References

Adult Obesity facts. (2014). Retrieved from Adult Obesity Facts

| Overweight & Obesity | CDC

Coleman , K. J., Huang, Y., Hendee, F., Watson, H. L., Casillas, R. A., & Brookey, J. (2014, February 6). Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare sustem . Surgery for Obesity and Related Diseases , 10(), 396-404.

Foster-Schubert, K., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., ... McTiernan, A. (2012, April 14). Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese post-menopausal women. Obesity, 8(). Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women - Foster-Schubert - 212 - Obesity - Wiley Online Library

Kim, J. J., Rogers, A. M., Ballem, N., & Schirimer, B. (2016, Aprin 18). ASMBS updated position statement on insurance mandated preoperative weight loss requirements . Surgery for Obesity and Related Diseases , 12(), 955-959.

Kritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., & Nicklas, B. J. (2015, Feburary 10). intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials.

MacMillan, A. (2011). After dieting, hormone changes may fuel weight regain . Retrieved from After dieting, hormone changes may fuel weight regain - CNN

Sczepaniak, J. P., Owens , M. L., Shukla, H., Periegos, J., & Garner , W. (2014, 14 November ). Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy 2008-2011. Obesity Surgery , 25(5), 788-795. Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 28-211 | SpringerLink

Yang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the united states-Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: a systematic review and meta-regression analysis. Oxford Journal of Medicine & Health , 29(1), 6-28. http://dx.doi.org/10.1093/epirev/mxm007

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Empire Chick

About Empire Chick, BSN, RN

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Specializes in Med/Surg, LTACH, LTC, Home Health.

I've been waiting three days for my treadmill to arrive. I've never done exercise, per se, but I maintained a weight of 138-150 pounds for years due to being active.....until recent years when the stress of dealing with the physical and mental status of my mom and daughter seemed to engulf my life and interfere with my personal freedom to come and go as I please.

Having made the decision to no longer allow this interference into my rights to my life​, I'm actually very excited about beginning the return transition to the new old me...hopefully by June 17th, the day my ship sails literally (5-day cruise).;)

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Specializes in Emergency Nursing.

This is an interesting examination of the available literature on this topic and a good read.

Just so I am clear on this, the article you are posting is actually the reposting of an evdience-based paper you are doing for one of your classes (an RN-to-BSN program or a grad school program)? You are interested in this topic but this is actually being completed as a requirement for a course right?

!Chris :specs:

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Specializes in ICU.

Yup. I took my assignment (RN to BSN) and tailored it to something that interested me deeply. Since I'm already doing research for a morificecript I really wanted to learn how to put together an evidence based paper. Lucky me, it was the focus of my fall semester class. Two birds.. One stone. :)

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Specializes in Home Health, Mental/Behavioral Health.

I voted diet and exercise.

I do believe in certain circumstances, though, that surgical intervention is a key to saving some people's life from obesity and giving them that much needed push over a dangerous hump.

Of course, fundamentally speaking it still comes back to what we put in our bodies and staying active.

I strongly believe in the difficult, but necessary practice of requiring a patient to lose some body fat first. It sets the individuals mindset up for what the future holds post surgery. Sort of gives the person a more plausible outlook on expectations to maintaining their progress/health.

And Great paper/article by the way :)

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