August 3, 2020
Obesity Management Strategies in PCP Setting
The subject for Research from United States University Approved List:
Effectiveness of obesity management strategies in [working adults or population] with [cardiac risk factors or disease] in primary care
PICOT Question:
Do obese adults (P) who engage in obesity management strategies with their primary care providers (I) and make lifestyle health changes (C) reduce their cardiac risk factors or experience health benefits (O) within a 3-month trial period (T)?
Project Purpose: Reducing Cardiac Risk Factors Through Lifestyle Health Changes
The leading cause of death in the United States continues to be heart disease (CDC, 2020). Heart disease encompasses coronary artery disease, heart attacks, heart arrhythmias, heart failure, and more. Other contributing conditions to heart disease include hypertension, diabetes, smoking, and high cholesterol. Consequently, primary care provider offices are where many cases of heart disease are identified. It is also the place where awareness, education, and treatment for healthy lifestyles have to begin (Schutz, Busetto, Dicker, Farpour-Lambert, Pryke, Toplak, Widmer, Yumuk, & Schutz, 2019). The purpose of this paper is to evaluate the potential influence of obesity management strategies in adults with cardiac risk factors in the primary care setting. As primary care providers (PCP), it is the responsibility of the PCP to provide the most up to date information of these health issues as well as education each patient and provide them with treatment options. The paper will look at what heart diseases are, their risk factors, obesity management strategies, prevention, and potential health benefits of a healthy lifestyle. Health benefits will be measured by a variety of markers to be outlined later.
Background and Significance: Cardiac Risk Factors
For both men and women, from every background, heart disease continues to be the leading cause of death in the United States (AHA, 2020). In 2017, 647,457 people died of heart disease. That’s 23.5% of all the deaths in the US for that year (Nichols, 2019). Related health conditions correlated with heart disease includes obesity, diabetes, hypertension, and hyperlipidemia (CDC, 2020). In addition to these health conditions, physical activity has been correlated to heart health (AHA, 2020). The importance of this topic is seen in its correlation to the leading cause of death as well as costing Americans over two hundred-billion dollars in lost wages, medication, and health care services (CDC, 2020).
The proposed project would seek to design a more proactive approach to America’s struggle with heart disease; starting in the primary care settings. Coinciding with recommendations from the World Health Organization, implementing lifestyle changes that promote increased physical activity in addition to a healthier diet, could reduce the risks of CVD in America (WHO, 2020). An even more progressive approach to reducing the risks of heart disease is a cardiothoracic surgeon named Dr. Steven Gundry. He has been practicing for over 40 years, has performed thousands of heart surgeries, and is considered an innovator in the field of cardiology. However, is 2002 he began treating his cardiac patients with dietary changes before surgical options were considered and has had positive outcomes with his patients (Gundry, 2020).
The idea that lifestyle health changes could alter a person’s long-term quality of life by reducing their risk of CVD is not mainstream and is exciting. The potential impact of health benefits, lowered healthcare costs, and less medication needs could shift the way primary care providers practice medicine. In another study conducted by the Mayo Clinic, researchers sited an ideal of cardiovascular health that included not smoking, maintaining an ideal body mass index, meeting physical activity guidelines, consuming a heart-healthy diet, maintaining a cholesterol level less than 200mg/dl, a blood pressure less than 120/80, and the absence of diabetes mellitus (Ramirez-Velez, Saavedra, Lobelo, Celis-Morales, Pozo-Cruz, & Garcia-Hermoso, 2018).
Imagine a health care system that did not rely so heavily on medication and procedures but promoted more complementary medical practices. The potential impact this concept could have on America’s health longevity and quality could be altered simply by getting back to the basics of healthy living through physical activity, weight reduction, and food choices (Zhang, Cash, Bower, Focht, & Paskett, 2020). The anticipated results of the PICOT study could validate previous findings and launch primary care providers into a prevention mindset rather than reactive. If the study findings support lifestyle health changes reducing CVD risks in 12 weeks, the benefits could promote change.
PICOT Formatter Clinical Project Questions
The study population for the PICOT would be adults, age 25-65, without a previous history of CVD. The intervention would consist of a form of physical activity for 20 minutes or more; four to six times a week. It would also include a primarily plant-based eating regimen that consisted of little to no sugar. The group size would ideally be 100 or more participants with a control group of similar size that make no changes to their daily lifestyle. The expected outcomes would be a reduction in CVD risks such as lowered cholesterol levels, lowered blood pressure, lowered A1c, and reduced BMI by the end of 12 weeks.
Conclusion
Cardiovascular disease continues to be the leading cause of sickness and death in the United States; costing Americans more than 200 billion dollars each year (CDC, 2020). As these figures continue to rise along with fast food chains, sedentary jobs and lifestyles, Americans continue to have chronic conditions such as diabetes, hypertension, and obesity that increase the risks for CVD (WHO, 2020). Primary care providers are in an optimal position to identify and influence their patients early and help empower them towards a healthier lifestyle. This can only be done by meeting patients with mutual respect and non-judgement as they try and educate patients about the health risks associated with obesity. As for family nurse practitioners, the primary care role can be a foundational place to provide information, explain health risks, and offer health management strategies as a means to achieving a reduced risk for cardiac health issues, lowered risk for additional health conditions, and a possible reduction in the need for medications as treatment. This detailed look at the effectiveness of obesity management strategies in adults with cardiac risk factors in the primary care setting can have a positive effect on health care practices by reducing the expenses and deaths associated with the issue as well as increasing the quality of life of patients both physically and mentally.
References
AHA. (2020). CVD prevention. American Heart Association. Retrieved from https://www.yourethecure.org/cvd_prevention
CDC. (2020). Heart disease in the United States. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/heartdisease/facts.htm
Gundry, S. (2020). A letter from Steven Gundry, MD. Dr. Gundry. Retrieved from https://drgundry.com/about/
Nichols, H. (2019). What are the leading causes of death in the US? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/282929
Ramirez-Velez, R., Saavedra, J., Lobelo, F., Celis-Morales, C., Pozo-Cruz, B., & Garcia-Hermoso, A. (2018). Ideal cardiovascular health and incident cardiovascular disease among adults: A systematic review and meta-analysis. Mayo Clinic Proceedings, 93(11), 1589-1599.
Schutz, D. D., Busetto, L., Dicker, D., Farpour-Lambert, N., Pryke, R., Toplak, H., Widmer, D., Yumuk, V., & Schutz, Y. (2019). European practical and patient-centered guidelines for adult obesity management in primary care. Obesity Facts, 12(1), 40-66.
WHO. (2020). Cardiovascular diseases. World Health Organization. Retrieved from https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1
Zhang, X., Cash, R., Bower, J., Focht, B., & Paskett, E. (2020). Physical activity and risk of cardiovascular disease by weight status among U.S. adults. PLoS One, 15(5), 1-13.
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