PICOT Statement and Literature Research

Subject: Nutrition
Type: Analytical Essay
Pages: 6
Word count: 1511
Topics: Weight Loss, Disease, Health, Medicine, Nursing, Obesity

Obesity is a chronic health problem affecting a significant proportion of the world’s population currently. Due to the high rates, scientists, nutritionists, and medical practitioners classify obesity as an epidemic and among the leading causes of death. Obesity and overweight are significant health risk factors because they contribute to other health problems such as diabetes, heart disease among others. This, therefore, calls for aggressive interventions strategies to curb the obesity epidemic. Changes in lifestyle remain the primary treatment interventions and are necessary for long-term weight maintenance and weight loss. Pharmacotherapy as well is another approach to treating obesity. This research seeks to compare different literature on the effectiveness of lifestyle modification and pharmacotherapy as management interventions for obesity in the adult.  

PICOT Parts and PICOT Statement

In adult obese patients, is lifestyle modification an effective weight loss or management intervention compared to pharmacotherapy within 12 months?

Patient – Adult obese patients 

Intervention – lifestyle modification 

Comparison – pharmacotherapy

Outcome – Weight loss /management 

Time – 12 months 

Peer Reviewed Research Articles

According to Orio et al. (2016), childhood and adulthood obesity is rapidly becoming an epidemic problem in the essence that it has both short-term and long-term effects on an individual’s health. The short-term effects are majorly psychological effects, and for a fact, obese children are more likely to develop psychiatric or psychological problems compared to non-obese children. The long-term effects include continuation of the obesity into adulthood thus affecting negatively on the individual. In this case, the individual is at high risk of developing morbidity and premature mortality. Some of the diseases related to obesity include; type 2 diabetes, dyslipidemia, hypertension, and cardiovascular diseases. Medical interventions such as pharmacotherapy are effective rapid measures for within the first twelve months but should be discouraged at all costs because of the side effects. Lifestyle changes should be encouraged due to the fewer side effects associated. This review provides more insights on the management of obesity in both childhood and adulthood focusing more on the lifestyle changes, which should be recommended. 

Montesi et al. (2016), points out that long-term weight management of obesity can be a difficult task. This is associated with weight regain and ultimate failure of the whole process even though many people record successful weight loss and maintenance in the long term. Randomized and long-term observational studies show that some of the factors that can allow weight loss maintenance. These pertain to the lifestyle of an individual, and they include eating low calorie, increased levels of physical activity, self-monitoring of weight, and low-fat diets. Cognitive factors, which can enable weight loss maintenance, include; confidence in losing weight, satisfaction with the achieved result, and reduced disinhibition. This article outlines that trials on lifestyle modification in the recent most protocols indicate long-term weight loss results. It is recommended to roll out lifestyle change as opposed to pharmacotherapy. The essence is that the data produced by study trials suggest that the best twelve-month period strategy to weight loss is featuring a non-physician counselor, which is lifestyle modification. 

This article outlines that weight loss should integrate a comprehensive program of exercise, behavior therapy, and diet which are prescribed alongside minimal or no lifestyle modification. Such a practice, according to Wadden et al. (2005), is bound to limit the benefits of therapy. It is outlined in the article that a one-year trial with 224 obese adults, three groups were subjected to lifestyle modification, pharmacotherapy and a combination of both. The result of the trials indicated that group lifestyle modification combined with medication gave higher rates of weight loss compared to either lifestyle modification alone or medication alone. The results of this study, therefore, underscore the significance of prescription of combined weight loss strategies rather than assuming lifestyle modification alone can achieve the desired results. 

Fujioka et al. (2010) outline that obesity researchers face a significant challenge of improving on the weight loss and maintenance. This article documents of the findings of a one-year randomized placebo-controlled study trial done on seven hundred and eighty-four individuals. Cannabinoid 1 receptor and taranabant are weight loss medications. In this study, it is reported that the effectiveness and safety of taranabant gives a parameter where modification of lifestyle and pharmacotherapy are subject to recommendation after diet-induced weight loss. This means that behavioral counseling alone cannot achieve the results as compared to a combination of taranabant and behavioral weight maintenance counseling. However, according to Merck and Co., taranabant further development is limited by its overall profile in use as a drug for maintaining obesity. 

Treatment approaches for obesity differ considerably, and the services offered by National Health Services on the same are patchy. Obesity cases as well are on the increase due to this. This article aims at comparing the practices, which are currently rolled out by dietetic clinics with new clinical approaches for patients with high risks of morbidity. Locally referred patients were invited and encouraged to attend the new lifestyle clinic. Contractual treatment was outlined with the individuals some having more time with dietitian and pharmacotherapy was offered where appropriate. The focus was to achieve changes in physical activity and dietary intake. 103 patients were involved in the trial and 34 discharged before the end of the program. The study concluded that lifestyle clinics are beneficial to changes in lifestyles. However, intensive weight loss and management package is required in the essence of incorporating pharmacotherapy into lifestyle changes to achieve maximum results. 

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According to statistics by Kushner et al. (2014), a third of the United States adults are obese. The treatment strategies, as well as identification of obesity, are still low. This, therefore, requires clinician engagement to assist and guide patients on how to address the underlying issues regarding the chronic disease – obesity. This article mainly describes the best lifestyle practices in managing obesity and as well demonstrates how they can be applied to individual patients. Kushner et al. outline that the first step in managing obesity is screening all adults for obesity and overweight. Medical histories of the patients should be ascertained including their psychosocial factors, physical activity patterns, dietary patterns, obesity pharmacotherapy, and metabolic adaptations to weight loss. The overall study indicated that assessing and screening patients for obesity is required. From that point, clinicians should roll out intervention strategies, which are most appropriate. Describing the history of the patients in terms of their physical activity, pharmacotherapy and psychosocial behaviors will allow the clinician determine which approach is the most suitable for each patient. The recommendation, however, is that lifestyle behavior and pharmacotherapy should be integrated to ensure quality results of weight loss and maintenance. 

Bray et al. outline that the use of medications in the treatment of obesity can be efficient but we ought to start from the realities associated with the treatment. Some of the realities are that the use of medication does not cure obesity, overweight is an imbalance of the energy intake and the energy expenditure, weight regain is the expected outcome when the use of drugs is stopped, and weight loss is projected to be at the rate of 10% when using pharmacotherapy. This article, therefore, outlines categorically that pharmacotherapy alone cannot be used in weight loss and maintenance. The essence is employing diverse strategies as directed by a physician, which entails counseling and initiation of a treatment method only if the patient is interested. 

In conclusion, weight gain and obesity are primarily up to an individual. One is responsible for monitoring his or her weight and in case this gets out of hand, lifestyle modification is the best strategy to outline compared to pharmacotherapy. From this literature review, people should consume healthy diets with low calories and exercise regularly to manage their weight or control obesity. 

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  1. Kushner, R. F., & Ryan, D. H. (2014). Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews. Jama, 312(9), 943-952. doi:10.1001/jama.2014.10432 
  2. Frost, G., Lyons, F., Bovill-Taylor, C., Carter, L., Stuttard, J., & Dornhorst, A. (2002). Intensive lifestyle intervention combined with the choice of pharmacotherapy improves weight loss and cardiac risk factors in the obese. Journal Of Human Nutrition And Dietetics: The Official Journal Of The British Dietetic Association, 15(4), 287-295. 
  3. Fujioka, K. Wadden, T. Toubro, S. Erondu, N. Chen, M. Suryawanshi, S. Carofano, W. & Shapiro, D. (2010). A Randomized Trial of Lifestyle Modification and Taranabant for Maintaining Weight Loss Achieved With a Low-Calorie Diet. First published: December 2010 DOI: 10.1038/oby.2010.67. Retrieved from; http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.67/full 
  4. Wadden, T. Womble, L. Berkowitz, I. R. Stunkard, A. (2005). Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. Source: PubMed. DOI: 10.1056/NEJMoa050156. Retrieved from; https://www.researchgate.net/publication/7476523_Randomized_Trial_of_Lifestyle_Modification_and_Pharmacotherapy_for_Obesity 
  5. Montesi, L. Ghoch, M. Calugi, S. Marchesini, G. & Grave, R. D. (2016). Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes. 2016; 9: 37–46. Published online 2016 Feb 26. doi:  10.2147/DMSO.S89836 
  6. Orio, F. Tafuri, D. Ascione, A. Marciano, S. Colarieti, G. (2016). Lifestyle changes in the management of adulthood and childhood obesity. Minerva Endocrinal. 2016 Dec; 41(4):509-15. PMID: 27600645. 
  7. Perri, Michael G.,McAllister, David A.,Gange, James J.,Jordan, Randall C.,McAdoo, W. George,Nezu, Arthur M. (1988). Effects of four maintenance programs on the long-term management of obesity. Journal of Consulting and Clinical Psychology, Vol 56(4), Aug 1988, 529-534. Retrieved from; http://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-006X.56.4.529 
  8. Apfelbaum M, Vague P, Ziegler O et al. Long-term maintenance of weight loss after a very-low-calorie diet: a randomized blinded trial of the efficacy and tolerability of sibutramine. Am J Med 1999;106:179–184. Retrieved from; http://www.sciencedirect.com/science/article/pii/S0002934398004112?via%3Dihub 
  9. Mathus-Vliegen EM; Balance Study Group. Long-term maintenance of weight loss with sibutramine in a GP setting following a specialist guided very-low-calorie diet: a double-blind, placebo-controlled, parallel group study. Eur J Clin Nutr 2005;59(Suppl 1):S31–8; discussion S39. 
  10. Bray GA, Greenway FL. Pharmacological treatment of the overweight patient. Pharmacol Rev 2007;59:151–184. Retrieved from; http://pharmrev.aspetjournals.org/content/59/2/151 
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