Introduction
Obesity is a global health challenge that contributes not only to the emergence of comorbidities in individuals but also creates a low quality of life among those affected by it. Lifestyle changes represent first-line therapy prescribed to overweight or obese patients. The most effective interventions resulting in weight loss tend to include a moderately reduced-calorie diet, increased exercise, as well as behavioral strategies to improve patient’s adherence to treatment. While bariatric surgery and accompanying medications have also been widely used to treat patients with obesity, it is essential to discover whether behavioral and lifestyle changes will improve health and reduce complications associated with surgery.
Behavioral and lifestyle interventions are essential to explore in the context of obesity treatment as there is no immediate fix to the healthcare challenge. For patients diagnosed with obesity who plan on undergoing surgery and those who do not, the key recommendation is to follow a balanced diet and gradually add physical exercises into the treatment plan. Besides, the lifestyle recommendations applicable to obese patients can also help prevent the condition among those who are overweight and are at risk. Thus, to reduce the burden of obesity, which is represented by 13% of the world’s adult population being obese, it is imperative to study the impact of behavioral lifestyle modifications (WHO, 2016). Changing one’s behavior presents a positive step in the direction of good health.
Research Questions, Hypothesis, and Variables with Operational Definitions
The current PICOT question applied to the study is the following: in obese patients (P), do lifestyle and behavioral changes, such as healthy eating, exercising, and positive habits (I), compared to weight loss surgery (C), improve patients’ health and reduce complications before and after surgery (O), in a six-month period (T)? Therefore, the core research question relates to discovering the impact of lifestyle modifications on improving the health and well-being of obese patients.
Research hypothesis: Lifestyle changes, such as behavioral modifications and healthy eating habits, can significantly improve obese individuals’ quality of life and reduce the burden of disease.
Null hypothesis: Lifestyle changes, such as behavioral modifications and healthy eating habits, cannot help reduce the burden of obesity among patients diagnosed with the condition.
In the current research, the independent variable is represented by the intervention that entails dietary and behavioral modifications aimed at improving the quality of life among patients diagnosed with obesity. The dependent variable is defined by the outcome of the intervention, which is the improvement of life and health quality among obese patients and the reduction of complications from bariatric surgery. In terms of variables’ operationalization, the proposed intervention is defined as the set of activities that entail making positive lifestyle choices and modifying one’s eating habits. These strategies are aimed not only at changing patients’ nutritional intake but also at teaching individuals about the importance of engaging in mild exercise and increasing its intensity over time. When it comes to the outcomes of the intervention, it is defined by the improved well-being of obese patients as well as their continuous efforts to engage in exercising and make healthier dietary choices. As a result of these changes, obese patients will experience fewer complications linked to their diagnosis and the possible weightless surgery.
Literature Review
Extensive research has been carried out on the topic of lifestyle modifications among patients diagnosed with obesity. Over a third of adults in the United States are obese, with their condition being associated with comorbidities ranging from cardiovascular diseases to increased risks of developing cancer (Fruh, 2017). Obesity is a complex disease that has multifactorial etiology, with “the genetic component interacting with individual, familial, behavioral, cultural, and environmental factors that lead to the expression of heterogeneous conditions and results” (Castelnuovo et al., 2017, p. 166). Nevertheless, behavioral factors, which include predominantly poor diets and physical inactivity, represent the critical proximal causes of obesity and condition-associated mortality and morbidity (Castelnuovo et al., 2017, p. 166). It must be noted that many individuals diagnosed with obesity have issues maintaining their weight loss despite the availability of strategies targeted at resolving this issue (Fruh, 2017). The treatment of obesity has been shown to require a biopsychological approach that includes lifestyle and medical interventions, self-management interventions, psychosocial support, as well as medication strategies, and weight loss surgery, if necessary (Fruh, 2017). Within such a framework, effective interventions that help patients lose weight tend to vary from one individual to another, depending on the factors that either support or limit their weight loss. Nurse practitioners have become the main healthcare providers who work on establishing targets for weight loss, providing support and motivation to patients, and guiding them through weight-loss programs (Fruh, 2017). The interventions aimed at reducing patients’ weight on a long-term basis have been shown to include behavioral modifications that significantly change individuals’ approaches to food and lifestyle, and it is the consistency in the adherence to intervention that gives the best results (Robinson et al., 2021).
Studies have revealed that mild exercising in combination with the introduction of dietary restrictions and healthier food choices have substantial health benefits (Wilson, 2020). Importantly, no specific diet has been shown to be more effective at addressing obese patients’ health concerns; however, it is imperative for individuals to engage in behavioral therapy and other strategies, ranging from the removal of trigger foods to self-distraction to avoid eating out of boredom (Wilson, 2020). It is also imperative to take into account the impact of mental health conditions, such as eating disorders, on the effectiveness of behavioral interventions to address obesity (De Giuseppe et al., 2019). Among patients diagnosed with eating disorders, cognitive behavioral therapy has been cited as an essential step in the direction of overcoming obesity while also addressing the mental health challenges that may trigger unhealthy eating (Castelnuovo et al., 2017). The main challenge remains regarding the long-term management of obesity, with issues establishing effective and consistent lifestyle modifications in behavioral settings (Castelnuovo et al., 2017).
Because of the multidimensional nature of obesity and its causes, scholars do not propose a “one size fits all” approach that will be effective at treating all obese patients. Each intervention is targeted to the specific needs of patients and the severity of their condition. Thus, the current study will help address this concern and help determine how well lifestyle modifications can work to reduce the burden of obesity among the populations diagnosed with the condition. It is expected that behavioral modifications will play a significant role in helping patients lose weight and reduce the impact of comorbidities and complications.
Theoretical Framework
In the current study, it is possible to apply the combination of grounded theory (GT) and Virginia Henderson’s theory of nursing. Grounded theory is imperative for discovering or constructing theory based on data systematically collected and analyzed with the help of comparative analysis (Chun Tie, Birks, & Francis, 2019). In the current research, GT is essential to apply because the framework avoids making assumptions about the phenomena studied and instead adopts a more neutral perspective of human action within the specific setting. It can help identify the situated nature of knowledge as well as the contingent nature of practice; hence, it is more effective at determining what actually happens within the context of the research. Moreover, considering the fact that the research is closely related to behavioral changes, grounded theory has shown to be flexible and respond to conditions that influence the change of behaviors.
Virginia Henderson’s theory is defined as the specific function of the nurse to help the individual, either sick or healthy, in the fulfillment of responsibilities and performance of activities contributing to health and recovery from a specific condition (Gonzalo, 2021). As a rule, nurse performs their duties unaided, expected to have high levels of strength, knowledge, and competence. The goal of nurses’ work in accordance with Henderson’s theory is to provide patients with the opportunity to gain independence in their self-care as soon as possible. The theory combines the concepts of the individual, the environment, and health as related to their ability to function independently from one another. Henderson’s theory is highly relevant to the current study because of the focus on behavioral changes for improving the quality of patients’ quality of life while also enhancing their independence in self-care.
Sample and Setting
The sample population will consist of 50 adults for the intervention group with an established diagnosis of obesity. The comparison group will also include 50 participants. It is projected to have nearly the same numbers of male and female participants to have the possibility of comparing the outcomes between men and women in terms of their adherence to behavioral modifications for weight loss. Participants aged 21 and older will be recruited to avoid issues with having to obtain informed consent from guardians or parents. All individuals will be provided written informed consent before participation while the study will occur in the outpatient setting.
Sampling Strategy
The participants will be recruited with the help of convenience sampling, which is the form of non-probabilistic sampling that entails involving participants based on their availability or proximity to the researcher. The participants will be approached in the clinical setting, predominantly at hospitals and clinics, and asked to participate. The researcher will get their contact details and provide all relevant information regarding participation.
Research Design
Considering the application of convenience sampling, a quasi-experimental design will be implemented; the design is experimental but lacks random assignment. The nonequivalent group’s design is the specific type of a quasi-experimental study and is its simplest and most widely used form. It needs the implementation of a pretest and a posttest for the treated group and its comparison. It is identical to the Analysis of Covariance design, although, the groups are not created through random assignment. In the design, the group of participants is the one being exposed to the treatment while the nonequivalent group is not exposed to the intervention, and the outcomes for each group will be compared.
Extraneous Variables
Extraneous variables represent all variables, except independent ones, which can affect the outcomes of the experiment. Therefore, it is imperative to ensure that it is the manipulation of the independent variable has an impact on the dependent ones. Situational variables, such as the living conditions of participants, are necessary to control because some settings may be less conducive to weight loss and positive behavioral changes. The researcher will apply standardized procedures to make sure that the environments are as similar as possible. Individual variables, such as mood, intelligence, possible anxiety, or stress, can also significantly impact outcomes. It is necessary to implement control through random allocation to the conditions of the independent variables.
Instruments
To collect data on participants’ progress, checklists and questionnaires will be used. Questionnaires serve as the primary source of information on a particular respondent. In the surveys, participants will be asked questions regarding their adherence to the behavior modification, any challenges along the way, as well as satisfaction with the treatment. The checklists are necessary to monitor patients’ weight and their meeting of short-term goals in terms of behavioral modifications. In terms of testing validity and reliability, internal consistency reliability represents the consistency of the score of individual instrument items that usually include several items for measuring several constructs. Internal consistency reliability will be checked with the help of Cronbach’s alpha. In addition, test-retest measures will be conducted to identify the correlation between the scores from administering one instrument to another, usually within the two to three-week interval. In contrast to pre-post-tests, no treatment should take place between the first and second administrations of the instrument for testing-retesting reliability.
Description of the Intervention
The intervention aimed at helping patients lose weight and develop positive lifestyle habits to enhance life quality entails several steps. To achieve substantial health benefits, it is recommended that participants engage in 150-200 minutes of mild-intensity exercise per week or between 75 to 150 minutes of high-intensity aerobic activity (Wilson, 2020). It is expected that patients will start with mild exercises and move on to increase the intensity of their physical activity to build their stamina and last longer walking, running, and doing aerobics. In addition to exercising, the participants will be subjected to a combination of cognitive-behavioral therapy and motivational interviewing. Patients will be presented with personalized dietary plans to guide them through the process of weight loss. In addition, they will be asked to implement environmental control measures such as removing foods that trigger their overeating and engaging in self-distraction to avoid eating out of boredom and any cravings. The key to interventions’ success entails planning ahead and not giving participants opportunities to make unhealthy choices.
Data Collection Procedures
Quantitative data to measure the effectiveness of the intervention will be collected with the help of questionnaires that will be disseminated digitally among respondents. A digital survey is the most cost-effective method that can capture large quantities of participants at once. The questionnaires will consist of close-ended questions that participants can respond with either ‘yes’ or ‘no’ (Desai & Reimers, 2019). They are straightforward in their implementation and will take minimum time for respondents, so they do not have to spend too much of their time answering questions and be dedicated to losing weight. Because the results are collected in real-time, it will be possible for researchers to analyze data quickly and decide on taking corrective measures.
Data Analysis
Survey analysis represents the process of analyzing results from the questionnaires completed by study participants. Considering the close-ended nature of questionnaires, it is expected that there will be no spontaneous answers, and the choices will be pre-determined. The questions will be designed to create easily quantifiable data that is easy to code and is final in its nature. It will also allow categorizing respondents into specific groups on the basis of respondents that they give. The quantitative data analysis will be conducted with the help of software that is accessible to the researcher, likely SPSS. It has an easy-to-use interface that is intuitive to use and thus allows performing analysis without the need for writing command syntax. The results of the survey will be cross-tabulated by subgroups.
Descriptive Statistical Tests
Descriptive statistics are used for describing the basic features of data within a study. Thus, it is necessary to apply because it provides simple summaries of the sample and the measurements. The univariate analysis will be implemented to examine cases one variable at a time. Specific characteristics to analyze will include the distribution, the central tendency, and the dispersion. The distribution will be measured to identify the frequency of variables and the range of values for the variables. It is also important to calculate the median, mode, and mean of the distribution of values. Finally, the standard deviation will be measured to accurately estimate dispersion and show the relationship between the set of scores within the data sample.
References
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Chun Tie, Y., Birks, M., & Francis, K. (2019). Grounded theory research: A design framework for novice researchers. SAGE Open Medicine, 7, Web.
De Giuseppe, R., Di Napoli, I., Porri, D., & Cena, H. (2019). Pediatric obesity and eating disorders symptoms: The role of the multidisciplinary treatment. A systematic review. Frontiers in Pediatrics. Web.
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Gonzalo, A. (2021). Virginia Henderson: Nursing need theory. Web.
Robinson, E., Boyland, E., Chisholm, A., Harrold, J., Maloney, N. G., Marty, L., Mead, B. R., Noonan, R., & Hardman, C. A. (2021). Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite, 156, 104853. Web.
WHO. (2021). Obesity and overweight. Web.
Wilson, K. (2020). Obesity: Lifestyle modification and behavior interventions. FP Essentials, 492, 19-24.