The key stakeholders involved in the process are the patients who will form a focus group, the nursing personnel, and the institution’s administration. To obtain approval and commitment from the patients, the issue needs to be described comprehensively but in a simple and approachable way to make sure they will benefit from the project. In a similar way, the nursing staff, which currently experiences difficulties stemming from the functional decline of the obese patients. Besides, a better understanding of benefits of the surgical practices compared to non-intrusive ones will aid the fellow staff in future and provide the additional materials for patient education. Finally, the organization’s leadership will primarily be concerned with the project’s ethical integrity and compliance with the regulations, so these aspects need to be isolated and clearly presented to secure the administration’s approval.
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Currently, obesity is among the top concerns in the US. It is widely publicized, well recognized by the public, and has been conclusively tied to a range of health problems and an overall decline of the health of Americans nationwide. Several mitigation strategies have been suggested by the healthcare industry, with lifestyle changes currently being the most common one. Despite being primarily associated with dietary changes, it also advocates changing eating habits and engaging in physical activities. This approach is currently visible on the national scale, with the appropriate regulations applied to restaurants and wellness programs being implemented by employers.
Another solution that gradually gains in popularity is the bariatric surgery. Thanks to the improvements made in the field of non-intrusive surgeries, the practice is currently safe and reliable enough to be applied on a wide scale. A growing body of evidence suggests multiple benefits of bariatric surgery, both in terms of immediate weight loss and the favorable psychological improvements (Yen, Huang, & Tai, 2014). However, both practices remain under-researched. The lifestyle changes have been proven to lead to weight loss but were not conclusively tied to health improvement, as the cholesterol and blood sugar levels of the patients have remained unchanged. Conversely, the bariatric surgery still poses a risk of unsuccessful surgical manipulation and requires abrupt changes in lifestyle prior to and after the operation. In other words, both strategies have their limitations. At the same time, there is not enough knowledge base to support either one as a preferable solution.
To merge the gap in understanding the issue, a research project is proposed which would assess the effectiveness of dietary interventions and lifestyle changes in comparison with the bariatric surgery to determine if any of the methods has a definitive advantage over the other. The recommended form of the research is a retrospective quantitative study which would assess two groups of patients, one of which has undergone the surgical intervention while the other was subject to health improvement methods targeting the lifestyle leading to obesity.
The patients who are subject to the medical weight-loss programs are preferable, as such programs are usually better controlled and recorded and exclude the possibility of improper implementation. The third group of patients which are not subject to any interventions is also required for the purpose of control. During the research, three major outcomes need to be assessed. First, the dynamics of change in body mass index need to be recorded to determine the effect of both interventions on the weight loss. Second, the health readings associated with obesity such as blood pressure, the level of cholesterol, and the level of sugars in blood need to be measured, as it has already been observed that they do not necessarily correlate with weight loss. Finally, the changes in mood, emotional, and psychological background must be accounted for, as they have also been observed to both correlate with and influence the process at least for the group engaging in the behavior-changing activity (Snyder, 2009).
The proposed research is justified by the following reasons. First, the suggested methodology will provide the results which are reliable enough to be used for further decisions on the matter of obesity. It is expected to strengthen the current understanding that the surgical intervention is more effective for the short-term loss of weight while the lifestyle changing practices would allow for the more long-term benefits. It is also possible to find the correlation between certain weight loss practices and health benefits, such as the connection of the normalized blood pressure to the to one of the intervention. The obtained knowledge would allow for a better response in terms of choosing the appropriate intervention and, perhaps more importantly, serve as a basis for the creation of educational material helpful to both the patients interested in the success of their practices and the nursing personnel currently lacking approachable means to illustrate the matter. Finally, the research may provide additional insights into the psychological side of the question. It has been previously established that the psychological aspect both influences and is itself affected by the change in BMI and related health outcomes. However, no material exists which would allow the comprehensive comparative analysis of the psychological effects of both interventions. Such information will likely increase the chances of developing successful practices.
Evidence from Literature
Previous research on the matter strengthens the implication of the necessity of eliminating the educational deficit. Several studies have already compared the effectiveness of the non-intrusive interventions to the bariatric surgery, albeit the focus of such studies was narrow. A study by Dixon et al. (2008) has shown promising results regarding the treatment of the type 2 diabetes by comparing two groups of 30 patients. Half of the focus group has undergone a laparoscopic adjustable gastric banding, while the other half was subject to conventional lifestyle-altering therapies such as standard treatment and intervention programs. The results indicated a sufficiently greater positive outcome for the surgically treated patients, with 73% demonstrating diabetes remissions versus only 13% in the group using the conventional therapy (Dixon et al., 2008). The mean weight loss percentage also differed greatly, with the bariatric surgery subjects losing 20.7% weight while the conventional therapy group only lost 1.7% (Dixon et al., 2008). The study had a lifespan of 4 years, and, while not blinded, was a randomized controlled trial, which confirms its credibility. On the other hand, the results are only applicable to a certain health issue, so aside from the difference in weight loss, the preference of the surgical intervention can only be hypothesized.
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A more comprehensive assessment was performed in the study by Martins, Strømmen, Stavne, Nossum, Mårvik, and Kulseng (2011). The trial involved 179 patients allocated non-randomly to four groups, with group A undergoing bariatric surgery and groups B, C, and D subject to non-intrusive lifestyle changing practices, such as a residential intermittent program, a commercial weight loss camp, and a hospital outpatient program, respectively (Strømmen et al., 2011). While the weight loss ratio was the biggest in group A, with 31 percent versus 15%, 13%, and 5%, respectively (Strømmen et al., 2011), the health outcomes were somewhat diverse. For instance, the increase in HDL cholesterol was the most prominent in groups A and C, and the changes in glucose and LDL cholesterol were insignificant throughout all groups (Strømmen et al., 2011). Overall, only a small percentage of comorbidities associated with obesity were positively resolved for group A, while the majority of changes has remained insignificant to positively conclude on the value of surgical intervention. The study confirms the need for a more holistic assessment of the outcomes, as it highlights the limitations of the benefits of bariatric surgery.
Finally, a study by Bächler, Papamargaritis, Bueter, and le Roux (2013) aimed at assessing the multitude of factors determining the validity of either surgical or traditional practices coupled with pharmacotherapy has shown similar results with some notable differences. First, it confirmed the weight loss rate of the patients who have undergone surgery to be superior to those using lifestyle improvement therapy. The 5-10 percent loss achieved by the latter was deemed insignificant for alleviating the risks associated with obesity. Interestingly, it was recognized as sufficient for improvements of patients suffering from diabetes (Bächler et al., 2013), which contradicts the conclusions by Dixon et al. (2008). On the other hand, the study also highlighted various marginally health-related factors, such as the possible financial benefits of surgery(when compared to medication-assisted non-surgical methods) and the possibility of better psychological effect (mostly derived from the successful weight loss). Currently, this inquiry is the most concise attempt of comparative analysis of the effectiveness, but its credibility is undermined by the study’s design and it is thus necessary to conduct a research assessing the mentioned factors directly to confirm the previous findings.
The research process will consist of observation of two groups, one of which will be subject to bariatric surgery and the other to non-intrusive lifestyle-changing educational practices and dietary alterations. The nursing staff will be required to acquire the patients’ consent in written form, after which, the monitoring activities will be performed on the daily basis. The readings will be consistent with those routinely obtained from the patients, so no workflow disruption is expected. The data necessary for the project can be determined by the project’s initiator and later distributed among the personnel during the dedicated meeting, which is not expected to take up much time. Aside from processing the results, the project does not require any outside or specialized knowledge, hence no need for training or educational sessions aside from simple instructions.
The nature of the project suggests minimal resource requirements. On the research stage, the general instructions can be issued to the nursing personnel in oral form, and the education will be introductory in nature, which means no need for external educational resources. Handout materials will be given to the staff which will list the required data. As some of the points of data are only relevant for the project, the dedicated forms are needed for the nurses to record it. Besides, the psychological state of the patients will be assessed via questionnaires and surveys, preferably in the print form. Neither of the mentioned print-out materials require the aid of a third party and can be achieved via the institution’s resource base. The only step which requires additional funding is the data management stage, which requires complex CDM software, so the additional partnership will be sought to cut the cost of the project. The process can be overseen and evaluated by the project’s steering committee with additional help from the nurse manager.
Bachler, T., Papamargaritis, D., Bueter, M., & le Roux, C. W. (2013). Treatment of Morbid Obesity: Intensive Lifestyle Intervention vs. Bariatric Surgery. Surgery Curr Res, 3(147), 2161-1076.
Dixon, J. B., O’Brien, P. E., Playfair, J., Chapman, L., Schachter, L. M., Skinner, S.,…Anderson, M. (2008). Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA, 299(3), 316-323.
Martins, C., Strommen, M., Stavne, O. A., Nossum, R., Marvik, R., & Kulseng, B. (2011). Bariatric surgery versus lifestyle interventions for morbid obesity—changes in body weight, risk factors and comorbidities at 1 year. Obesity Surgery, 21(7), 841-849.
Snyder, A. G. (2009). Psychological assessment of the patient undergoing bariatric surgery. The Ochsner Journal, 9(3), 144-148.
Yen, Y. C., Huang, C. K., & Tai, C. M. (2014). Psychiatric aspects of bariatric surgery. Current Opinion in Psychiatry, 27(5), 374-379.