This paper aims at answering the following PICOT question: In patients 40-60 years old diagnosed with obesity (P), does diet and physical plans modifications (I) compared with diet management (C) reduce patient weight and improve healthy lifestyles (O) in 6 months (T)? When assessing these causal relationships, it is essential to consider two points. First, it is crucial to distinguish between only dietary modifications and the addition of physical plans modifications to them. Second, to specify the previous point, it is necessary to differentiate between types of interventions aiming at changing patients’ physical activity.
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Mouodi et al. (2019) answer the first question using a sample of northern Iranian middle-aged patients diagnosed with obesity. Having separated the sample into three groups with one group involved in training exercises, the study shows a significant difference in overall results in favor of the physical activity modification added to a dietary change. Thomas et al. (2015) discuss the second question focusing on the comparison of the Internet Behavioral Intervention (IBI) results and education-only Internet-delivered eating and activity (IDEA) control group. The findings show that the former intervention exhibits more significant results in terms of obesity treatment in a long-term perspective. Moreover, patients involved in the IBI were more likely to use weight control-related strategies than patients who received IDEA support.
For the nursing practice, both articles’ findings imply that nurses and nurse practitioners (NPs) should not only educate patients in terms of the benefits of physical activity but also provide patients with detailed advice on physical activity programs. Since NPs help patients identify their goals and develop a personalized plan to achieve them, the articles’ results help to improve NPs’ performance as personalized counselors.
Using the Articles to Answer the PICOT question
The chosen articles help to answer the PICOT question in two ways. The article by Mouodi et al. (2019) helps identify the benefits of adding physical plans modifications to diet management. This study’s advantage is the exact match of the sample in terms of patients’ age, i.e., 40-60 years old patients. However, the sample consisted of non-patient adults. Nonetheless, the results correspond to the PICOT question since the initial research question concerned the assessment of parameters related to obesity (anthropometric measures, blood pressure, fasting blood glucose, and serum lipid profile (Mouodi et al., para.1). The study also involved 4-months interventions on healthy lifestyle behaviors and dietary intake. The article by Thomas et al. (2015) reveals differences in two specific Internet-based interventions in physical activity plans. This study helps specify the statement about the advantages of adding physical plans modifications to the treatment of obesity. Although the sample is wider than in the initial PICOT question, the timeline of Thomas and co-authors’ (2015) findings is in exact correspondence with it: the secondary outcomes were measured six months after the start of interventions.
Methods of Study Used In the Articles
Both studies use the method of randomized clinical trial (RCT). The study focuses on determining the degree of differences in results between compared groups. Although randomized controlled trials are a powerful tool, ethical and practical considerations limit their implementation. It is often considered unethical to expose patients to treatments that are less advanced than other methods.
The study by Mouodi et al. (2019) consisted of a sample of 300 non-patient middle-aged adults (40-60 years old). The exclusion criteria included illiteracy, pregnancy or breastfeeding, severe diseases, medical history of diabetes. The sample was divided into three groups: the high-intensity group (intervention in dietary and physical activity plans), the low-intensity group (intervention in dietary plans and provided with an educational package), and the control group (provision with only an educational package). The data was collected with the Health Promoting Lifestyle Profile and 2-days 24-h recall questionnaires. The parameters, including weight loss, were measured twice: before the intervention (at baseline) and after (at the end of the 4th month). The main limitation of the study is its northern Iranian-focused sample. It makes the results context and culture-specific and calls for further validation.
The study by Thomas et al. (2015) consisted of 154 patients aged 18-70 years. One of the main inclusion criteria was access to a personal computer and the Internet. The exclusion criteria are similar to Mouodi et al. (2009). There were two groups: 77 individuals assigned to the Internet Behavioral Intervention (IBI) and 77 individuals assigned to the Internet-delivered eating and activity control (IDEA) group, considered as a control group. The primary outcome was measured after three months (weight-loss parameters), and the secondary outcome was measured after six months (changes in weight-control behaviors parameters). The main difference with the study of Mouodi et al. (2015) is the measurement of different parameters in primary and secondary outcomes.
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Results of Study
The study reported by Mouodi et al. (2015) shows that the increase in healthy lifestyle choices and overall weight progress was the most significant in the high-intensity group which experienced modifications in dietary and physical activity plans. From a long-term perspective, high-intensity intervention demonstrated a significant influence on healthy lifestyle choices. As Moudie et al. (2019) report, the introduction of physical activity plan modifications leads to an improved healthy lifestyle among middle-aged individuals in a long-term perspective, whereas calorie deficit is effective only in a short-term period. These results help identify scientific evidence for including physical activity in obesity treatment. It is crucial to base the clinical recommendations on scientific evidence for two reasons. First, evidence-based medicine must use scientific evidence to support its claims. Second, the involvement of scientific proof enhances the persuasiveness of clinical advice.
The article by Thomas et al. (2015) helps NPs themselves in structuring their advice and formulating the obesity treatment strategy. It is not just educational materials only, but it is the developed program of interventions that helps achieve weight loss and improve a healthy lifestyle from a long-term perspective. Internet Behavioral Intervention, which consisted of “12 weekly multimedia behavioral lessons, a website for submitting self-monitoring data, and weekly automated feedback provided to the participant on their progress to date” (Thomas et al., 2015, p. 10), promoted interventions in dietary and physical activity plans. The control group was assigned to an “education-only” control condition. The results demonstrate that IBI led to significantly larger weight losses. The reason for that is the inclusion in a community and the presence of timely feedback on their progress. For the nursing practice, it means that to be effective in a long-term perspective, interventions in physical activity plans should consist of educational measures and full feedback on the progress and the individual’s achievements.
The anticipated outcomes for the PICOT question match the outcomes of the chosen articles. It is common knowledge that physical activity is a favorable addition to the overall obesity treatment weight. Thus, it was safe to state such a hypothesis for the PICOT question. However, it was essential to understand whether there is scientific evidence for that and whether the extent to which the modification of physical activity plans is significant enough to advocate such intervention in the treatment plan. Another critical thing to consider was a type of intervention in physical activity plan modification. Contrary to the initial hypothesis, not every intervention exhibits noteworthy results in a 6-months perspective.
Mouodi, S., Hosseini, S. R., Ghadimi, R., Cumming, R. G., Bijani, A., Mouodi, M., & Zahed Pasha, Y. (2019). Lifestyle Interventions to Promote Healthy Nutrition and Physical Activity in Middle-Age (40-60 Years) Adults: A Randomized Controlled Trial in the North of Iran. Journal of research in health sciences, 19(1), e00434.
Thomas, J. G., Leahey, T. M., & Wing, R. R. (2015). An Automated Internet Behavioral Weight-Loss Program by Physician Referral: A Randomized Controlled Trial. Diabetes Care, 38(1), 9–15.