Obesity Management in Adult Primary Care
Managing obesity in the primary care setting for patients who are over the age of 18 years requires a serious examination of the key risk factors which contribute to this problem and how it can contribute to multiple comorbidities and reduced quality of life. Primary care providers have a responsibility to be proactive in their efforts to support patients and to provide them with the best possible resources to improve their quality of life and wellbeing through targeted education and other interventions to minimize obesity risks as best as possible. Primary care providers must share their knowledge and support for interventions which will have the best interests of each patient in mind and recognize motivation and other factors relative to obesity risk. The purpose of the paper is to implement a weight management program to promote weight loss and to reduce health risks in patients, including the development and administration of all available treatments to improve outcomes.
Background Information
Obesity is a serious public health epidemic among children and adults and can contribute to reduced quality of life and an increased cost of healthcare services and treatments for patients due to multiple comorbidities and other complications. Specifically, two-thirds of adults in the United States are considered overweight or obese and are often affected by type 2 diabetes, the emergence of cardiovascular disease, and a greater risk of developing some types of cancer; therefore, it is the responsibility of primary care providers to develop strategies that will be useful in treating patients with obesity and which stimulate weight loss in patients (Fitzpatrick et al., 2016). However, it is known that there are few proven interventions which are applied within healthcare organizations and which have a significant impact on reducing weight and improving quality of life in patients.
In accordance with the recommendations made by the Institute of Medicine (IOM) (2012), it is important to consider the following aims as part of a comprehensive strategy to reduce obesity: Increasing the amount of physical activity of each individual and making this process habitual so that it is part of the daily routine; facilitating easier choices regarding the consumption of healthier foods among adult population groups by reducing access to high sugar and high processed foods; and supporting an increased marketing push to promote increased physical activity and proper nutrition throughout the adult population. These steps are critical in addressing some of the most important health challenges within the adult population and in ensuring that all possible options are explored to promote exercise and physical activity and to improve health and quality of life among adult patients who are obese and have numerous health complications or other challenges which impact their long-term health prognoses.
Purpose Statement
The purpose of the project is to implement an evidence based weight management program in the primary care setting which is designed to emphasize physical activity and proper nutrition through enhanced behavioral modifications among patients who are overweight or obese; furthermore, this program is designed to reduce Body Mass Index (BMI), weight, and waist circumference among patients where no current program exists within the primary care practice setting, enabling nurses to provide critical education, guidance, and support to patients to meet their goals and objectives to stimulate weight loss and improved weight management.
Quality Improvement Model
The Quality Improvement Model chosen for this discussion is the Modified 5 As, which is defined as the following parameters to implement counseling among primary care providers for obese patients to stimulate an intervention to improve weight loss outcomes: Ask by using motivational interviewing to ask questions of patients to address their weight concerns; Assess each patient and the information that is available, such as BMI, along with psychosocial factors and root causes related to weight gain; Advise by improving the relationship between provider and patient through open dialogue and guidance in a professional yet sensitive manner; Agree to a treatment plan and allow the patient to clearly understand its specifics and how the plan will be executed; and Assist in carrying out the course of treatment and provide as much support as necessary to accomplish these goals in a timely manner (Vallis, Piccinini-Vallis, Sharma, & Freedhoff, 2013). This model is provided in the Appendix. Orem’s Theory of Self-Care is applicable to this model because it is often difficult for individuals to engage in self-care activities without a structured support system in place which is designed to improve the outcomes of the intervention and to ensure that patients receive the best possible support to accomplish the goals of the intervention (Eke, 2017). It is important to guide patients when an obesity-based intervention is in place because it is very difficult to overcome the challenges of completing the goals of each step of the intervention individually without a solid support system in place (Eke, 2017).
Synthesis/Overview of Evidence
For this discussion, the evidence that was obtained offers a variety of perspectives regarding the use of interventions to stimulate weight loss in overweight or obese adults. For instance, reducing the risk of cardiovascular disease is a primary objective of any intervention method and requires an examination of key guidelines and recommendations set forth to reduce these risks, such as those supported by the American Heart Association and the American College of Cardiology (Jensen et al., 2013). Lifestyle interventions are of critical importance to this process and require individuals to engage in specific behavioral modifications that will contribute to weight loss and improved quality of life (Brauer et al., 2015). Behavioral interventions are discussed at length throughout the literature and include the approval of interventions at the primary care level by the Centers for Medicare and Medicaid Services (CMS) (Wadden, Butryn, Hong, & Tsai, 2014). Furthermore, evidence addresses the use of motivational interviewing as part of a weight loss intervention to improve behavioral outcomes (Barnes & Ivezaj, 2015). However, although there is information regarding the use of behavioral approaches to weight loss, these practices as part of a larger framework to improve weight loss are not supported by policies that are fully integrated into the practice setting (Dietz et al., 2015).
Prior evidence in this area of study is often represented by a systematic review and meta-analysis technique, including interventions which are designed to lead to behavioral changes (Booth, Prevost, Wright, & Gulliford, 2014). Systematic reviews provide a summary of existing evidence through literature searches and determine if an existing intervention or policy is supported by credible evidence. Furthermore, systematic reviews such as the study by Texieira et al. (2014) considers the risk of relapse which is common when lifestyle interventions for obesity prevention are conducted. Therefore, it is necessary to consider this level of evidence as supportive of the risks associated with these interventions and how to best overcome the challenges that many patients and providers face when attempting to implement these interventions among different adult population groups (Texieira et al., 2014). These practices are essential to the discovery of new resources that may be applied to the practice setting that will have lasting benefits for patients and will contribute to effective outcomes over the long term for patients who face obesity and have specific healthcare complications due to this condition.
PICO Question
The following PICO question is considered for this discussion: Population: Adult patients who are 18 years and older. Intervention: A weight management program focuses on diet and exercise behavior modification. Comparison: Currently, there is no intervention in the practice. Outcomes: to reduce BMI /weight/waist /circumference and increased physical activity
In the development of the PICO question, the following key terms were search to identify relevant studies: primary care , obesity, weight loss and nutrition, weight loss and exercise, weight management, and behavioral modifications in weight loss. A number of electronic databases have been selected due to their relevance for this subject. These databases are the Cochrane Collaboration, PubMed, CINAHL and Scopus.
The inclusion and exclusion criteria for this review of the literature was any study published in the last 5 years that followed an experimental, quantitative or qualitative design, which focused on the knowledge of diabetes self-management in the adult population and interventions to improve this knowledge. This date range was selected in order to ensure that the most up to date These key terms are important in addressing some of the most important challenges of the primary care setting and in recognizing the value of organized interventions with the intent to stimulate weight loss among obese adults.
Conclusion
Managing obesity among adults in the primary care setting is of critical importance because obesity is a serious public health issue with numerous consequences for patients. It is important to develop interventions which can have positive benefits for adult patients and to encourage the integration of motivational interviewing, counseling, and behavioral modifications to stimulate weight loss and reduce obesity in patients. When weight loss is achieved, patients will experience fewer complications and comorbidities and improve their quality of life. This is of critical importance in addressing how to improve weight loss outcomes in patients who are obese and for primary care organizations to introduce interventions that will have positive and lasting effects on patients. A proposed intervention involving adult patinets18 years and older will determine if weight loss can be achieved through improved dietary and physical activity among patients who are overweight or obese and who have multiple comorbidities.
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