Running head: EVIDENCE BASED RESEARCH

1
Summary
The competencies fulfilled by this assignment are:
2.1.3 Apply critical thinking to inform and communicate professional judgments.
2.1.6

Engage in research-informed practice and practice-informed research.

2.1.10 Engage, assess, intervene, and evaluate with individuals, families, groups, organizations,
and communities evaluate and assess interventions.
In writing this paper I learned about and practiced the steps involved in evidence based
practice (EBP). The first step in the process is to formulate a question to answer a practice need.
Once again, I chose an issue that is, not only of interest to me because of personal experience,
but pervasive in society today; the problem of obesity. I used a theoretical practice setting
(2.1.10) which was a weight loss support group and then used the CIAO acronym to formulate
my research question. For the second step, which is to search for empirical evidence, I used the
bottom-up approach in my research and located eight to ten major articles that I thought would
address the issue of obesity and show that it is indeed a social problem (2.1.3). The third step is
to critically appraise the relevant studies to determine if the treatment outcome is valid, reliable
and if it was done in an unbiased way (2.1.10). In step four I chose three interventions that I felt
could be effective and provide the desired outcome and discussed the research and results of each
one as well as the strengths and limitations and assessed any ethical or cultural issues that may
be present (2.1.6). Since our practice settings were theoretical we could not apply steps five in
which we would obtain any necessary training before implementing the chosen intervention and
formulating measurable treatment goals. We also could not apply step six which is to evaluate,
gather feedback and then share the outcome with interested colleagues.

EVIDENCE BASED RESEARCH

Evidence Based Research: Obesity

Lynda Reimer
SW 3810
Wayne State University

EVIDENCE BASED RESEARCH

3
Obesity

This topic is of interest to me because I have struggled with weight issues since
adolescence. So many of the people in my life. My theoretical practice setting is a weight loss
support group. The group includes eleven women, attendance varies but usually we have seven
or eight members at a bi-weekly meeting. The majority have struggled with their weight since
adolescence, and some have gained weight during a pregnancy. Individually they have tried a
variety of both formal weight loss programs, and self-guided regimens with varying degrees of
success. Unfortunately, none have been able to fully maintain the losses. In discussing why this
happens the group members believed the following issues to be responsible for the inability to
succeed; emotional eating, loss of motivation due to slow weight loss, and difficulty making life
style changes that would help to maintain weight loss. Since nothing thats been tried to date has
worked, it is time to research possible therapies that will help the group members to overcome
these issues and make it possible to maintain the weight loss and lead a healthier, happier life.
CIAO
If obese individuals who have not been successful at losing weight and maintaining
weight loss due to emotional eating, unsustainable motivation, and inability to follow weight loss
regimen follow a behavioral weight-loss program with motivational interviewing or a new
cognitive behavioral therapy or dialectical behavioral treatment, will they be able to control their
emotional eating and maintain lasting weight loss?
Obesity: A Social Problem
The following evidence shows that obesity is a social problem. Obesity has been declared
an epidemic in our country for the past twenty years. According to the Center for Disease

EVIDENCE BASED RESEARCH

Control one-third of all U.S. adults are obese and another one-third are overweight and it affects
seventeen percent of children as well (Ogden, et al, 2012). Government costs of treating obesity
and its related illnesses are estimated at $190 billion annually. Individually the average cost to
an overweight person is $1500 a year in medical expenses alone (Carroll, 2013). Obesity reduces
the quality of life and increases the risk of diseases such as Type 2 Diabetes, heart, lung, and
liver disease and certain cancers. Obesity related diseases are the second leading cause of
preventable death in the U.S. (Fuden, 2013). Although obesity is affects all income levels there
is some disparity. Women with higher income and education levels are less likely to be obese
than low income women with less education. In men, those with higher income are prone to
obesity, regardless of education level (Ogden, et al, 2012).
Research Method
Using the school library system I searched for research using the following key words;
obesity, weight loss therapies, emotional eating, weight loss maintenance, and motivation. I
found a dearth of studies and read through the abstracts of eight to ten articles. I based my
selection on the results shown in the three interventions and whether or not I felt the group
members would be open to using the interventions chosen.
Interventions
The first research article was a randomized controlled study aimed at testing a new form
of cognitive behavioral treatment which was based on CBT-BN, a successful therapy used to
treat eating disorders, in particular, bulimia nervosa. This new form of CBT was intended to help
participants curb overeating and increase their physical activity level. It also concentrated on
thought processes which are believed to block the success of maintaining weight loss. To

EVIDENCE BASED RESEARCH

determine effectiveness it was compared to behavioral therapy (BT), one of the leading
treatments for obesity, and guided self-help (GSH), a minimal intervention therapy. The 150
participants were randomly assigned to the three groups, all groups were guided in lowering their
caloric intake. The CBT and BT groups received weekly individual sessions with the final 14
sessions focusing on maintenance behaviors. The GSH group received two sessions at the start
and a limited number of 20 minute phone sessions throughout. All groups were followed up for
three years after the final session. The study results showed that although program completion
rates were high, most participants lost weight but then regained it; showing that CBT is no better
than BT at helping participants avoid regaining lost weight.
The goal of the second intervention was to improve treatment outcome for behavioral
weight loss programs (BWLP) using a stepped-care (SC) approach. All participants were
enrolled in a behavioral weight loss program (BWLP) with minimal intervention. Participants
who were slow to progress were then enrolled in motivational interviewing (MI) as well.
Motivational interviewing is a method that is designed to improve a persons motivation to make
changes. The BWLP participants attended 20 weekly group sessions of 6-12 people that were
75 minutes long. Those in the BWLP + MI group met weekly in individual sessions that were 4560 minutes long. Study results showed that those who received MI not only had better weight
loss outcomes, but also had more positive change in behaviors, including increased time spent
exercising each week.
The third article was based on four case studies involving participants who were chosen
based on the results of several questionnaires including the Emotional Eating Questionnaire.
Emotional eating is a common barrier, not only to weight loss but to successful maintenance of
lost weight. This study looks to discover whether cognitive behavioral therapy (CBT) and

EVIDENCE BASED RESEARCH

dialectical behavioral therapy (DBT) can alleviate this issue. Of the four participants two
received cognitive behavioral therapy and two received dialectic behavioral therapy. The study
consisted of 22 individual therapy sessions with follow-up sessions at 1, 2, 4, and 8 weeks. The
CBT sessions addressed beginning and maintaining weight loss, barriers to weight loss,
increasing activity level, body image, weight goals and healthy eating. The DBT sessions were
aimed at teaching mindfulness, emotional regulation, distress tolerance, relapse prevention and a
final review of all topics.
At the 4 week follow-up session participants receiving DBT reported having a difficult
time initially with using mindfulness training but improved with practice. By the final 8 week
follow-up they had lost 8-10% of body weight and showed a 4-5 point reduction in BMI. Those
receiving CBT began to have difficulty following the prescribed weight loss regimen by the 4
week session and although they were able to understand that emotional eating is mainly an issue
of distorted thoughts, they were not able to consistently confront those thought processes
effectively. At the 8 week follow-up session they showed a 0.5% reduction in weight and 0.2-0.3
reduction in BMI. Although all participants lost weight, those receiving DBT lost more weight
and were more successful at maintaining their progress.
After reading and comparing the three interventions I immediately eliminated the first
intervention since it was proven that the new CBT and BT did not improve weight loss
maintenance in study participants. Results showed that 98% of participants regained all their lost
weight at the end of the three year follow up. Although the DBT and MI studies were smaller
studies, the results showed some promise. I would suggest the use of a combination of the second
and third interventions. Namely, BWLT plus MI, because those participants showed an increase
of positive changes in adherence and the ability to maintain weight loss, two of the issues

EVIDENCE BASED RESEARCH

reported by support group members. My suggestion to the group would be to begin with
individual MI sessions in order to set individual goals. Then proceed to group sessions using the
LEARN program which is a behavioral therapy that teaches moderate lifestyle changes to
promote weight loss and increase physical activity. During the group sessions I would also teach
some of the DBT modules, specifically the mindfulness, emotional regulation, and distress
tolerance to address emotional eating among group members.
Evidence Based Practice
If used correctly the Evidence Based Practice process can lead to modes of therapy for clients
who have not responded to standard treatments used in social work. In my theoretical practice
setting the clients would likely continue the cycle of losing and regaining weight or they may
have given up altogether. To begin the EBP process I used information gathered from clients in
the group to form a practice question using CIAO format. In my search for evidence based
research I used the bottom-up method and found many research articles related to my practice
question. Not wanting to spend hours reading every study, I chose several that I found
interesting. After thoroughly reading the chosen studies I decided that only two would suit the
clients problem. The final steps are to implement the intervention and evaluate the outcome and
obtain feedback from clients. In this practice setting EBP led me to discover interventions that
show promise where standard therapies had failed in effectiveness.
Some advantages of EBP are improvement in effective interventions that are backed by evidence,
and the opportunity to learn from the expertise of others. It expands our own knowledge base and
promotes life-long learning. Some possible disadvantages are the amount of time required for
research, possible lack of access to necessary databases, and the cost of training to learn
interventions.

EVIDENCE BASED RESEARCH

8
References

Carels, R. A., Darby, L., Cacciapaglia, H. M., Konrad, K., Coit, C., Harper, J., Versland, A.
(2007). Using motivational interviewing as a supplement to obesity treatment: A steppedcare approach. Health Psychology, 26(3), 369-374. doi:10.1037/0278-6133.26.3.369
Carroll, D. (2013, March 13). [Web log message]. Retrieved from
http://www.dailyfinance.com/2013/03/09/the-price-of-americas-obesity-epidemic/
Cooper, Z., Doll, H., Hawker, D., Byrne, S., Byrne, S., Bonner, G., Eeley, E., & O, M. (2010).
Testing a new cognitive behavioral treatment for obesity: A randomized controlled trial
with three-year follow-up. Behavior Research and Therapy, 48(8), 706-713. doi:
10.1016/J.BRAT>2010.03.008
Fuden, S. (2013, April 2). [Web log message]. Retrieved from
http://publichealthonline.gwu.edu/cost-obesity-infographic-nphw/
Glisent, K., & Strodl, E. (2012). Cognitive behavioral therapy and dialectic behavioral therapy
for treating obese emotional eaters. Clinical Case Studies ,11(2), 71-88. doi:
10.1177/1534650112441701
Ogden C., Kit B., Flegal K. Prevalence of Childhood and Adult Obesity in the United States,
2011-2012. JAMA.2014;311(8):806-814. doi:10.1001/jama.2014.732.