DIET MODIFICATION - Health - Database Search String and Implementation Assessment Answer

November 30, 2018
Author : Andy Johnson

Solution Code: 1HII

Question: Diet Modification

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Diet Modification Health Research Analysis Report

Assignment Task

RESEARCH QUESTION HOW EFFECTIVE IS DIET MODIFICATION IN PREVENTION OF OBESITY IN ADOLESCENTS?

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Solution:

Background

Obesity has become a serious public health issue worldwide. The increasing trend has been seen in various developed countries and poses a threat for the healthcare system. Countries have increased their healthcare spending in an order to reverse the current disease burden. Decreased obesity rate denotes highly efficient healthcare system. Despite putting resources and efforts the problems still persist especially overweight and obese people. Obesity is one of the important health indicators for any country. Developed countries are facing problems to decease the morbidity rate among obese people as it increases the risk of heart diseases, cancer, and diabetes. People with body mass index of 25 (overweight) and 30 or above are at higher risk of obesity associated morbidity.

The obesity rate has increased in Australia over the years. Based upon Australian health survey, the rate is 28% which is higher than OECD countries. The rate is higher among males (70%) in comparison with females (55%) (Australian Bureau of Statistics, 2013). It varies in different age groups (18-24, 25-34, 35-44, 45-54, 55-64 and above 75 years). People within older age group were more obese than adults. On the other hand, approximately one third of the US population has BMI of 30 while more than half have BMI above 25. It is resulted into huge economic cost around US$60 billion for the country per year to combat against the current situation. Obesity associated type 2 diabetes has increased tremendously.

The most important considering point is childhood obesity which cannot be ignored. It can give raise to adult obesity if not treated on time. Both the types of obesity are increasing significantly particularly among Americans in comparison with African, and Hispanic. Children’s are at risk of developing obesity due to social and environmental factors (Friedman, 2009).

Life style and diet pattern both have contributed for high severity of obesity globally. It is expected that the number of obese cases will increase as the countries will become richer. In reverse to developed countries, developing countries have witnessed obesity among people with people with lower BMI. In India, more people are suffering from type 2 diabetes along with obesity. It amplifies the health consequences of obesity for developing countries (Friedman, 2009).

As mentioned earlier, life style modification and diet modification could be the contributing factors for controlling obesity. It is not mandatory that availability of free calories could lead to obesity among all. Only certain number of people become obese due to other factors also. Biological system is responsible to keep balance between energy intake and output. Too much fat deposition would probably lead to obesity and diseases while little fat would cause starvation and other health issues. Hence genetic variants and environment both play an important role to control the fat metabolism. Sudden increase in availability of calories to an undernourished person could lead to obesity. Availability of calories is one of the important environmental factor for high obesity rate. It is quite possible that controlling these factor could decrease the BMI which in turn will reduce obesity. By increasing energy expenditure or controlling food intake an individual can control obesity.

Various medical therapies are available to control the deposition of fat. It is anticipated that preventive strategies are more effective than use of clinical methods or drugs. In an order to control the obesity cases, various guidelines have been framed for healthcare professionals detailing about the preventive measures, regular examination, family counselling, promoting healthy behavior, and lifestyle habits etc. Nursing practitioners face problems in managing obesity especially of child and adult. They have been found with low self-efficacy in preventing obesity associated problems. Also, the following nursing practices are important such as family counseling skills, behavioral management skills, and patient motivation skills. It has been realized that the above stated skills are the important training needs for nursing practitioners. The prevention practices followed by the nurses could be an important healthcare strategies for obesity associated morbidity (Larsen, 2006).

As discussed earlier that environmental factors contribute for obesity so dealing with these factors could probably deal with the public health issue. Hence it is very important to have trained nursing staff along with other healthcare professionals to counsel the person whether an adult or a child in an effective manner. Trained nursing staff could be an asset for the healthcare system. They can motivate a person to adopt healthy habits to reduce the chances of obesity. Providing training for better communication and counseling skills would probably produce effective results as they would be able to motivate people. This could be an effective healthcare strategy in dealing with high obesity rate (Larsen, 2006).

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Research Problem

It is evident from the above discussion that obesity among adolescents has increased globally and has contributed more for public health burden in most of the countries. High childhood obesity continues in adulthood and increases the disease burden. Observing the fact that, environmental and genetic factors both are the important attributes for obesity. The genetic factors are difficult to control hence the obesity rate could be decreased by changing the environmental factors which are quite easier to manage comparatively. There are several environmental factors to focus upon but changing diet pattern could be an effective preventive strategy. At the moment, it is difficult to judge the effectiveness of these preventive measures.

Research Question

Based upon the above study background it is important to find out the following research question:

How effective is diet modification in prevention of obesity in adolescents?

Research Framework

Above stated research question can be further evaluated based upon PICO framework. The paper highlights as issue of obesity among adolescents population. They could be suffering from various serious illnesses along with obesity and high BMI. The research can be done to find out the ways of effective preventive measures for the mentioned population. The outcomes would decide the effectiveness of several measures taken for managing obesity.

Methodology

Evidence based methodology has been adopted to support the effectiveness of diet modification to prevent obesity among adolescents. In this regard, five peer reviewed articles have been analyzed to provide insights about the importance of changing behavior pattern of diet for the control of obesity. These selected paper clearly define the positive relation of diet modification for reversing the order of obesity.

Research Articles

In a longitudinal study design, 145 obese adolescents including female (94) and male (51), aged 11-18 years, were observed for a period of 6 months. The study was conducted to validate the role of behavioral support, dietary modification, nutritional education, physical activity to reduce the energy intake in an order to reduce the obesity. It is evident from the research study that reduction in energy intake could be an effective preventive strategy to reduce the obesity rate among adolescents. Dietary modification focuses upon motivation level to modify high risk eating behavior while other interventions stress upon behavioral change, physical activity, and counselling (Ning et al, 2014).

Metabolic disturbances are associated with obesity. In comparison with normal weight children, serum metabolites are present with altered concentration in obese children. Hence the research study analyze whether these metabolic changes stabilize with weight loss. The study finds out a strong relation between diet modification and metabolic disturbances. After 1 year life style intervention program, these changes can be stabilized along with weight reduction. Though it is an important strategy but it requires modification in long run (Reinehr et al, 2015).

Motivation to participate in lifestyle modification program could produce positive results in long term. Obese children who participated in 1 year lifestyle modification program were found with reduced BMI for next 5 years. This behavior sustained over a longer period of time. The intervention program includes nutritional course, individual psychological therapy, group treatments for an individual and parent. An important considering point is that children at younger age are easier to motivate comparatively (Reinehr et al, 2010).

Dietary and physical intervention program could successfully produce positive results. Dietary intervention includes counselling sessions of parent in the beginning and then meetings along with children to change the diet pattern. It was aimed to motivate the children and the family to follow the diet plan to reduce the weight. In the follow up meetings, they were counseled for nutritional education mentioning about food habits, and food choices. They were trained to control the stimulants of overeating (Nemet et al, 2006). It is hard to comment upon the sustainability of the above mentioned intervention as in longer run it might not be followed once the weight has reduced.

Mentoring can promote healthy food habits among obese children proved by another research study. It is evident that mentoring can have a psychological impact to adopt healthy behavior that could play an important role for a longer time. It helps to improve knowledge, attitude, and improved BMI. Smith (2011).

Results

Article Reference Population & Study Design Intervention or Issue Comparison in relevant Outcomes
1. Ning et al (2014)

  • Obese adolescents aged 11-18 years, 145 participants including female (94) and male (51)
  • Longitudinal study design

Behavioral support, dietary modification, nutritional education, physical activity for 6 months Results were compared with baseline information of body weight and BMI

  • Reduction in energy intake is significantly associated with obesity reduction among adolescents
  • Decrease of 100kcal/day is related with reduction in .30kg body weight, 0.9kg/m2.

2. Reinehr et al (2015)

  • 80 obese children substantial weight change
  • 80 obese children with stable weight
  • Longitudinal study design

One year life style interventions Results were compared with baseline information related with metabolic disturbances in obese children

  • Metabolic changes were found related with diet modification and physical activities due to obesity and they normalize with weight loss.

3. Reinehr et al (2010)

  • Longitudinal study design
  • A total of 663 obese children aged 4-16 years participated
  • Randomized controlled trial

  • Motivation program for lifestyle change.
  • Study population was observed for 5 years after motivating them by participating in the lifestyle motivation program

Results were compared with baseline information of BMI reduction

  • Children at younger (4 years) age successfully reduced their BMI
  • Children of 8 years need modified intervention programs.

4. Nemet et al (2006)

  • 12 obese children observed for 3 months’ time period
  • Randomized controlled trial

  • Dietary – physical activity intervention program to measure bone strength, body composition, fitness among obese children

Results were compared with control group (12 obese children in control group)

  • Significant difference in change in body weight, body fat were observed in intervention versus control group.
  • Dietary – physical intervention increases the bone strength in obese children.

5. Smith (2011)

  • 72 obese children were studied
  • Randomized controlled trial

  • Use of teen mentors to promote healthy diet and physical activity

Results were compared with control group (non- mentored children group)

  • Greater improvement in BMI among mentored children
  • Mentored children followed healthy diet pattern in comparison with non- mentored children

 

Discussion

Medical advancement helps healthcare professional to adopt the new practices to improve the well-being of the people. In addition to traditional medical practices, doctors are using newly developed techniques known as best practices. Better patient care has been the focus of healthcare service delivery.

Previously, opinion of experienced professionals were being considered. Now medical industry has seen shift from using knowledge of others to evidence based practice (EBP). In today’s scenario, medical practices based upon scientific research and data are being implemented globally.

It is very important to understand the role of nurses for implementing the effective strategies to prevent the obesity in a particular geography. Therefore, evidence based practices become essential to provide quality healthcare services. For obesity prevention, it is essential to know the behavior of an individual rather than relying on medications. In this regard, nurses should be aware of evidence based practices in an order to deliver healthcare services effectively. They must have develop skills to find out the information sources to gain knowledge about the new medical practices. We need to understand the attitude of nurses towards evidence based practice as they might be reluctant in the beginning (Majid et al, 2011).

In a different scenario, it has been observed that nurses also feel that EBP training must be implemented and those who are trained for EBP must be involved for training of others. This would probably encourage the nursing staff to follow such type of practices. Despite showing positive attitudes towards EBP, barriers are creating hindrance to move forward.

Earlier nurses were following the instructions of the medical team rather than involving themselves into clinical decision making process. In comparison with traditional practices, use of evidences into nursing profession has improved the patient care. Now they are able to make justifiable and effective decisions by improving their knowledge through evidences (Majid et al, 2011).

A number of research evidences are available to show the positive attitude of nurses for EBP. They consider it as an important aspect of patient care. Along with this, there are barriers which restrict them to access the new evidences such as lack of time. It has been investigated that most of the time they are engaged with several tasks to perform so they cannot keep themselves updated about these practices. Another barrier is related with self-efficacy of nurses as they perceive themselves having moderate level of skills. Few of them do not feel to learn the advanced practices as they do not understand the jargons of scientific articles and are unable to interpret the statistical results. It has been find out that the acceptance level is low for EBP. The reason behind is that thousand number of research articles are published monthly and then annually. Hence it becomes difficult to access the relevant data for the nurses as they are not trained to extract the correct information through different sources (Majid et al, 2011).

Another considering point is that nurses do not have enough authority to decide about the patient’s health which demotivate them to gain new clinical knowledge. Lack of resources and adequate information technology also act as barriers for nurses (Majid et al, 2011).

The hospital management should take necessary steps to develop literacy skills among nurses. The management should undertake research activities to build up EBP competencies. Before implementing, the hospital must work in finding out the knowledge gap of the nursing staff. Then conducting briefing sessions to make them aware about the usefulness of EBP. Otherwise nurses would feel as an additional burden to do some research imposed as hospital policies. The hospital management must understand the literature searching skills of the nurses to provide the proper guidance. Each hospital must conduct a survey of the staff to know the barriers and supporting factors to adopt EBP.

Most of the research studies have been conducted for developed countries and authentic information is not available for Asian countries pertaining to the same issue. Therefore studies are required to understand the scenario on larger scale world widely.

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