Effective Method for Controlling Adult Obesity

1. M I Effective Method for Controlling Adult Obesity Telana Fairchild, BSN, RN University of Massachusetts- Worcester- Graduate School of Nursing Weight Watchers is a registered trademark of Weight Watchers International, Inc. Motivational Interviewing Findings PICOT Background and Significance Alexander, et al., 2011: Number of times each of the “5A’s” were used during provider visits Mitchell, et al., 2012: Insurance covered cost for participants to attend WW for one year. How does the Primary Care Provider guided behavior modification, transtheoretical model- stages of change (TTM SOC), for diet and physical activity for the obese (BMI ≥ 30kg/m2) adult patients (seventeen years and older) compare to a standard commercial weight loss program, Weight Watchers (WW) concerning weight loss of at least five percent in three months and maintenance for at least year? • Obesity: body mass index (BMI) (≥30kg/m2) • 2012- 35.7% of adult US- an increase • 2008 cost ≈ $147 billion • Mortality risk of BMI ≥ 35kg/m2 = 40-60% • WHO: national concern, all ethnicities, all demographics, and all ages • Preventable and modifiable condition • Contributes to several chronic and comorbid illnesses • Health People 2020: weight reductions of 5-20% • 5-20% significantly decrease morbidity associated with obesity • NIHHS treatment guidelines from 1998 • Accepted manuscript for new guidelines • 2013 ≈78.4 million obese adults- slight decrease Literature Search • Databases: PubMed, Cochran Library, and Ovid • Terms: “obesity AND motivational interviewing,” “obesity AND transtheoretical model,” “obesity AND weight watchers,” “obesity treatment AND primary care,” and “obesity AND five A’s” (7,412) 35.7% ≈78.6 million ≈72.5 million Pinto, et al., 2013: Weight change between behavior; WW and combined Johnson, et al., 2008: TTM used to target multiple behaviors vs no treatment Total number of articles obtained using the search terms 7,412 Eliminated articles published prior to 2008, without available full text, subjects other than humans, languages other than English, and ages less than 17 years. 7,187 Number of articles after deleting duplicates 97 Eliminated duplicate articles 128 Eliminated studies during a review of the abstract that included specific populations of subjects based on ethnicity, culture, or health condition instead of target population 58 Number of articles after deleting specific populations that couldn’t be generalized to target population. 39 NIHHS Treatment Algorithm 1998 AHA/ACC/TOS Treatment Algorithm 2014 Jebb, et al., 2011: Comparison of national guidelines to WW Fuller, et al., 2012: Cost analysis of Jebb, et al., 2011 Number of articles using TTM SOC or similar behavioral change model (MI, 5A’s), Provider/physician guided, or WW or similar program as the independent variables 20 Eliminated studies which did not evaluate the target independent variables 19 Eliminated studies which did not evaluate the target dependent variable 8 Articles selected for further review 12 Weight Watchers General practice After further review article found not to include weight loss and had poor representative of the TTM 1 Weight loss was included as a dependent variable 11 Future Research Articles for studies with strong levels of evidence, strong sample sizes representative of the target population and reliable and valid data measurements 9 Articles eliminated based on poor design, weak level of evidence and weak sample size 2 • Target outcome should be weight reduction as there is proof this will lead to reduction of other chronic illness and comorbidities • Need to include all demographics and ethnicities • For understanding weight loss maintenance, research should look at 5-10yrs • If MI is researched use a tool to measure appropriate use and application of MI • More focus now on cost as well, insurance companies need to consider covering cost of these visits or at least reducing cost Newest literature search included additional studies with strong levels of evidence, strong sample sizes representative of the target population and reliable and valid data measurements 12 Articles found with new search of the aforementioned process 3 Recommendations • As a future provider: • Patient-centered treatment using MI • Understand barriers • Use WW program when possible • Or use similar plan using nursing visits and nutritionist • Insurance companies need to cover cost • For R.M.: referral to the WW program for weekly sessions with PCP behavior guided modifications biweekly until 10% weight loss is achieved. Needs weight reduction of 30% from his current baseline achieve 10% reevaluate his need and desire to continue his weight loss regimen using MI and treat accordingly with the goal of another 10% until normal weight is achieved. Synthesis Scenario • Level of evidence: I-VI, most II • Reliable internal validity • Bias unlikely • Target outcome 5-10% reduction • Population: Caucasian, females, 30-40’s, • BMI 35-38kg/m2 • New guidelines are supported • MI and WW together • Influential factors: willingness, adherence, and accuracy, ethnicity, time, cost • WW and number of session (adherence) • Compared: WW ≥ MI • Weight loss involves multiple behaviors • Use of all 5 A’s • 55 year old gentleman • CPE- seven years ago • Lost sister this past month r/t MI • PMHx: None • SHx: None • Medications: None • Family Hx: heart disease, colon and breast CA, and diabetes • Diet: fast food restaurant, skips breakfast, pasta, meat, potatoes. Denies fruit and vegetables. Drinks soda and coffee with cream and sugar. Limited water intake. • Exercise: none, no interest. • Today: BMI: 35kg/m2, B/P: 164/83 and total cholesterol: 284. • Dx: Obesity, HTN, HL References: Ahern, A.L, Olson, A.D, Aston, L.M., & Jebb, S.A. (2011). Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS. BioMedCenteral: Public Health, 11. Retrieved from http://www.biomedcenteral.com/1471-2458/11/434 Alexander, S.C., Cox, M. E., Boling-Turer, C.L., Lyna, P., Østbye, T., Tulsky, J.A., … Pollak, K.I. (2011). Do the five A’s work when physicians counsel about weight loss? Family Medicine, 53 (3), p. 179-184. Armstrong, M.J., Mottershead, T.A., Ronksley, P.E., Sigal, R.J., Campbell, T.S., & Hemmelgarn, B.R. (2011). Obesity management: Motivational interviewing to improve weight loss in overweight and/or obese patients: A systematic review and meta-analysis of randomized controlled trails. 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