Running head: WEIGHT AND BODY MASS INDEX REDUCTION
Evidence-Based Research on Weight and Body Mass Index (BMI) Reduction Programs Implemented By Nurses Lisa Chee NURS-211 February 28, 2013 Professor Williams
WEIGHT AND BODY MASS INDEX REDUCTION
Obesity is a major healthcare issue in the United States. It is defined as a medical condition, in which there is an accumulation of excess body fat that causes pressure and stress to body organs, resulting in the development of adverse disease processes. According to Berman & Snyder (2012), individuals who are obese, with a body mass index (BMI) greater than 30 kg/m2, are at risk for chronic health problems, such as hypertension and diabetes mellitus. In 2007, the United States Department of Health and Human Services (USDHHS) estimated about 300,000 individuals die annually due to chronic diseases associated with overweight and obesity. Diseases reported include: heart disease, diabetes, stroke, arthritis, cancers and depression (Turner, Thomas, Wagner & Moseley, 2008). Statistically, the percentage of adult and childhood obesity is increasing annually across the United States. Between 2003 to 2004, the percentage of obese adults increased from 23% to 32% (Turner et al., 2008). Additionally, in 2009, the USDHHS estimated about 11% of two to five year old children, 15.1% of six to eleven year old children and 17.8% of 12-19 year old teenagers are overweight (Berman & Snyder, 2012). Thus, it is crucial for nurses to implement effective evidence-based weight and BMI reduction programs to decrease unnecessary weight gain, in all ages, to avoid long-term health complications associated with obesity. According to Giddens (2012), the most effective measure to avoid obesity is prevention. This includes consuming a healthy diet and engaging in a minimum of 150 minutes of physical activity weekly. However, once an individual has been diagnosed with obesity, intervention is required, and an effort to lower the individuals weight and BMI is crucial. As a result, nurses have been trying to provide effective interventions for their patients. Over the years, several weight management programs, focused on decreasing the BMI of overweight and obese individuals, have been studied and implemented by nurses and interdisciplinary healthcare
WEIGHT AND BODY MASS INDEX REDUCTION
professionals to improve the quality of life of individuals affected by obesity and obesity related diseases. Sabin, Ford, Hunt, Jamal, Crowne and Shield (2007) conducted a qualitative, observational study in which they monitored the effect of lifestyle and dietary changes on the Body Mass Index Standard Deviation Scores (BMI SDS) of 137 obese children. Their main goal in this study was to reduce the participants BMI SDS of -0.5 or greater. Sabin et al. (2007) conducted their study over a three and a half year period and recruited children, who were referred to the obesity service center at the Bristol Royal Hospital for Children, and their parents or guardians for consultation with a pediatrician, dietician and a health and exercise specialist. According to Sabin et al. (2007), previous studies have shown beneficial results to the child when the parents are involved; thus, they emphasized family behavior changes to facilitate weight control. This included the avoidance of snacking on foods high in carbohydrates, the reduction of consuming drinks high in sugar content (e.g. soda), regulating healthy meals and negotiating treat days (e.g. chocolates and sweets), as appropriate. In their study, they also encouraged the children, and their families, to participate in a free, two hour weekly sports session to enhance physical activity. Throughout the study, weight was measured using a digital scale and height was measured using a stadiometer. BMI SDS was then calculated and adjusted for age. As a result, 83% of participants who followed through with the program achieved an overall reduction of BMI SDS with 28% achieving the target reduction of -0.5. Sabin et al. (2007) concluded that education, lifestyle/ diet modification and encouragement are key factors in weight reduction. Turner et al. (2008) utilized a similar approach in which they focused on how diet, exercise and patient education affects body mass in 109 participants. They utilized a quasi-
WEIGHT AND BODY MASS INDEX REDUCTION
experimental design and collected/evaluated data over a 12 week interdisciplinary Wellness Program. A total of 12 sessions, which included three exercise sessions and nine group meetings, were included in the program. The program comprised of two physicians, two psychologists, a nurse practitioner, an exercise physiologist and a licensed patient educator. In their study, Turner et al. (2008) educated participants on both healthy and unhealthy behaviors and surveyed participants regarding their readiness to alter their nutrition and physical activity levels. Three dietary plans (e.g. low calorie, low fat or low carbohydrate) were offered in this study. The program provided free access to a local fitness center which included all access to exercise equipment and a 90 minute aerobics class, to facilitate an increase in physical activities. They then evaluated the participants adherence to nutritional change and increase in physical activity. Research data was collected utilizing an intake questionnaire which addressed changes in activity level and physical or emotional well-being pre and post program completion. At each meeting, participants were weighed on a Tanita TBF body composition scale and information regarding their weight, BMI, body fat percentage and basal metabolic rate were recorded. Turner et al. (2008) concluded that there was no difference in BMI based on diet choice; however, an increase in physical exercise significantly reduced BMI, with a positive correlation in the increase number of exercise session and mean weight loss. Lastly, Sarvestani, Jamalfard, Kargar, Kaveh and Tabatabaee (2009) conducted a study where they observed how behavior modification could improve eating habits in obese adolescent females. Similar to studies conducted by Sabin et al. (2007) and Turner et al. (2008), Sarvestani et al. (2009) also enforced patient education on healthy decision making and increasing physical activities in their study. Sixty adolescent girls were randomly selected from two schools to participate in a six months, quasi-experimental designed study. The sixty participants were
WEIGHT AND BODY MASS INDEX REDUCTION
equally divided into experimental and control groups. In the experimental group, participants engaged in four-hour structured sessions, which included two hours of behavior modification education and two hours of yoga therapy, over a course of 16 weeks. In the control group, participants attended only three of the sixteen sessions. Data regarding each individual BMI and Dutch Eating Behaviour Quesionnaire Score were recorded. Body weight was measured in light clothing with bare feet and height was measured in bare feet with a stadiometer. Data was then analyzed using SPSS and two sample ttests were used to examine the differences between the two study groups. Sarvestani et al. (2009) concluded that there is a statistically significant difference in BMI in the experimental group in comparison to the control group (-1.07 kg/m2 vs. 0.24 kg/m2, P<0.001); thus, consistently engaging in healthy lifestyle choices and physical activities significantly contributes to BMI and weight reduction. Overall, all three studies provided significant evidence that programs focused on increasing physical activities, monitoring diets and increasing patient awareness are the key factors in managing weight gain in obese patients. Specifically, as evidenced by studies conducted by Turner et al. (2008) and Sarvestani et al. (2009), the greatest impact on weight and BMI reduction is not so much altering the patients diet, but motivating and encouraging the individual to engage in physical activities. Based on the evidence gathered above, as a future nurse, I can educate and stress the importance of routine physical activities and healthy diet choices to the population affected by obesity to prevent the progression of severe health diseases and to reduce their overall BMI scores. With this information, I can also educate the younger population on how to prevent obesity utilizing the same approach.
WEIGHT AND BODY MASS INDEX REDUCTION
References Berman A., & Snyder S. (2012). Kozier & Erbs Fundamentals of nursing: Concepts, process, and practice, (9th ed.). Upper Saddle River, NJ: Pearson Education. Giddens, J. (2012). Concepts for nursing practice. St. Louis: Elsevier. Sabin, M., Ford, A., Hunt, L., Jamal, R., Crowne, E., & Shield, J. (2007). Which factors are associated with a successful outcome in a weight management programme for obese children. Journal of Evaluation in Clinical Practice, 13 (2), 364-8. Sarvestani, R., Jamalfard, M., Kargar, M., Kaveh, M., & Tabatabaee, H. (2009). Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls. Journal of Advanced Nursing, 65 (8), 1670-5. Turner, S., Thomas, A., Wagner, P., & Moseley, G. (2008). A collaborative approach to wellness: Diet, exercise, and education to impact behavior change. Journal of the American Academy of Nurse Practitioners, 20 (6), 339-344.