NSG7020 - Week 9 project

2

Week 3 Project

Elizabeth Hernandez

South University

Dr. Crystal Dodson

NSG7020

April 2nd, 2025

Obesity causes chronic disease, lowers quality of life, and increases health costs. The PICOT question must be well-defined to facilitate a targeted literature search to inform clinical Obesity is a complex, chronic health condition associated with increased risk for diabetes, cardiovascular disease, reduced quality of life, and higher healthcare costs. Addressing this issue requires evidence-based strategies that support sustainable weight loss and maintenance. A well-structured PICOT question is crucial for guiding clinical practice improvements and effective literature searches.

Proposed PICOT Question

In adults with obesity (P), how does participation in a structured weight management program (I), compared to self-directed weight loss efforts (C), affect long-term weight maintenance (O) over a 12-month period (T)?

This PICOT question is focused, clinically relevant, and aligned with the goal of identifying best practices in obesity management. Structured weight management programs typically integrate dietary counseling, physical activity, behavioral strategies, and, in some cases, pharmacological support. Evidence suggests these programs yield better long-term results than self-directed efforts, which often lack accountability and structured support (Wadden et al., 2023).

Silveri et al. (2024) highlight the importance of accountability frameworks in weight loss interventions, suggesting that programs with regular follow-ups, multidisciplinary teams, and patient-centered goals contribute significantly to sustained weight outcomes. By comparing structured interventions with self-guided efforts, this question aims to explore the real-world effectiveness of formal weight loss programs, a question directly tied to clinical decision-making and patient care.

The final PICOT question allows for a targeted review of interventions proven to improve weight outcomes over time. This specificity enhances the potential for actionable findings in clinical and community settings.

Engagement Question

What elements do you believe are most essential in making a structured weight loss program successful and sustainable over time?

 

References

Silveri, O. C., Gallardo, N. A., Chandy, R. J., Edwards-Hampton, S. A., & Feldman, S. (2024). Accountability Frameworks in Medical Weight Loss Programs: A Comprehensive Literature Review.  Cureus. https://doi.org/10.7759/cureus.73474

Wadden, T. A., Chao, A. M., Moore, M. B., Jena Shaw Tronieri, Iwamoto, S. J., Amaro, A., Leonard, S., & Jakicic, J. M. (2023). The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities.  Current Obesity Reports,  12(4). https://doi.org/10.1007/s13679-023-00534-z

Week 3 Project

Elizabeth Hernandez

South University

Dr. Crystal Dodson

NSG7020

April 2nd, 2025

Weight management for obesity is a worldwide public health issue that requires evidence-based solutions. Sustainable weight reduction treatments need an understanding of psychological, behavioural, and technical variables. This study encompasses research on weight management, including self-monitoring, food, exercise, and digital health programs. This study evaluates various methods to determine the most effective long-term weight reduction and maintenance strategies. Critically assessing each study's evidence provides a comprehensive understanding of its strength and reliability. This study synthesis will inform weight control clinical guidelines and public health strategies.

PICOT Question

In adults with obesity (P), how does participation in a structured weight management program (I), compared to self-directed weight loss efforts (C), affect long-term weight maintenance (O) over a 12-month period (T)?

Database List

· PubMed

· CINAHL (Cumulative Index to Nursing and Allied Health Literature)

· Cochrane Library

· Embase

· PsycINFO

· Scopus

References

Björkman, S., Wallengren, O., Laurenius, A., Eliasson, B., & Larsson, I. (2022). Locus of control and self-efficacy in relation to 12-month weight change after non-surgical weight loss treatment in adults with severe obesity – A clinical cohort study. Obesity Medicine, 32, 100409. https://doi.org/10.1016/j.obmed.2022.100409

Abstract:

Background: Sustainable dietary, behavioural and lifestyle changes are necessary to accomplish weight loss.

Aim: Evaluate impact of internal motivation, locus of control and self-efficacy on non-surgical weight loss treatment in patients with severe obesity.

Methods: A total of 1196 patients, Body Mass Index ≥35 kg/m2, referred to obesity treatment were included. Visual analogue scales for motivation, locus of control and self-efficacy were completed before starting weight loss treatment.

Results: A total of 601 patients (42% drop out) completed 12-month weight loss treatment. After 12 months, 94.6% in the Very Low Energy Diet (VLED) group and 79.4% in the dietary treatment group had a weight loss of ≥5% of their body weight. No statistically significant associations were found between achieved weight loss in the VLED group, and locus of control or self-efficacy. Achieving ≥15% weight loss by dietary treatment was related to a higher score on self-efficacy compared to those who lost <5% in weight or dropped out.

Conclusion: Self-efficacy appears to be important for weight loss when on dietary treatment without VLED. Attrition rate was higher among patients with lower score on self-efficacy at baseline. The study indicates that psychological factors associated with adherence to, and completion of weight loss treatment deserve attention.

Level of Evidence: Level II (Cohort Study)

Rationale: This study follows a clinical cohort of patients undergoing weight loss treatment and examines outcomes over 12 months. Since it tracks participants over time without randomization, it qualifies as a cohort study.

Fanning, J., Nicklas, B., Furlipa, J., & Rejeski, W. J. (2022). The impact of dietary weight loss, aerobic exercise, and daylong movement on social cognitive mediators of long-term weight loss. Journal of Behavioral Medicine, 46(3). https://doi.org/10.1007/s10865-022-00359-6

Abstract:

This report contrasts the impact of a dietary weight loss intervention (WL) paired with aerobic exercise (EX) and/or sitting less and moving throughout the day (SL) on self-efficacy for walking (hereafter walking self-efficacy) and satisfaction with physical functioning (hereafter satisfaction). Additional analyses examined dose-response associations between change in weight and changes in these key outcomes. Older adults (N = 112; age = 70.21

4.43) were randomized to 6 months of WL+EX, WL+SL, or WL+EX+SL followed by a 12-month maintenance period. All groups reported increases in walking self-efficacy at month 6 with greater improvements in WL+EX and WL + EX+SL. Only WL+SL demonstrated improved walking self-efficacy at month 18. All conditions demonstrated improved satisfaction scores at both time points. Changes in walking self-efficacy and satisfaction were negatively associated with change in weight over the 6-month intervention and after the maintenance period. These results support the utility of WL + SL for improving key social cognitive outcomes in aging.

Level of Evidence: Level II (Randomized Controlled Trial - RCT)

Rationale: The study involves randomization of participants into different intervention groups (WL+EX, WL+SL, etc.), making it a randomized controlled trial.

Hall, K. D., & Kahan, S. (2020). Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America, 102(1), 183–197. Ncbi. https://doi.org/10.1016/j.mcna.2017.08.012

Abstract:

Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain. This review describes our current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.

Level of Evidence: Level V (Narrative Review)

Rationale: This study is a review article summarizing current knowledge on weight loss maintenance rather than presenting original data.

Hallock, R., Ufholz, K., & Patel, N. (2024). Self-Monitoring of weight as a weight loss strategy: A systematic review. Current Cardiovascular Risk Reports, 18(11), 163–172. https://doi.org/10.1007/s12170-024-00746-5

Abstract:

Purpose of Review: Gauge the effectiveness of self-monitoring of weight for weight loss.

Recent Findings: Daily self-monitoring of weight results in increased weight loss, or improved weight maintenance as compared to infrequent or no self-monitoring of weight. Self-weighing is most effective when tied with other behavioral interventions including tracking caloric intake and physical activity tracking.

Summary: Self-monitoring of weight is an effective behavioral weight loss intervention which allows patients to track their progress, but also allows them to connect daily life activities with their weight, fostering real-time feedback that allows them to make more informed and personalized decisions related to dietary choices, physical activity, and lifestyle medicine.

Level of Evidence: Level I (Systematic Review)

Rationale: Since the study is a systematic review, it represents the highest level of evidence by synthesizing multiple studies to determine effectiveness.

Lin, H., Xie, S., Xu, D., Wu, F., Huang, R., Wu, H., Zhang, Y., An, J., Yang, M., & Deng, N. (2023). Evaluation of a workplace weight management program based on WeChat platform for obese/overweight people in China using the RE-AIM framework. 34, 102275–102275. https://doi.org/10.1016/j.pmedr.2023.102275

Abstract:

A Weight Management Program (WMP) is a critical and promising approach to losing excess weight and maintaining a healthy lifestyle for obese/overweight people. This study used the RE-AIM framework to retrospectively evaluate a WeChat-based workplace WMP that include low- and high-intensity interventions — self-management (SM) and intensive support (IS) — designed for employees with varying levels of health risk at a Chinese company. Both interventions incorporated with a variety of m-health technologies and behavioral strategies. While the IS group additionally received personalized feedback on diet record and intensive social support. Approximately 26% of all overweight/obese employees in the company enrolled in the program. Both groups lost a significant amount of weight at the endpoint (P < 0.001). In comparison to the SM group, the IS group had significantly higher level of compliance with self-monitoring. At six-month, 67% of individuals reported no additional weight gain. The WeChat-based WMP has received widespread praise from program participants and intervention providers in spite of difficulties encountered. This comprehensive and meticulous evaluation revealed both the strengths and weaknesses of the program, which will assist in improving implementation and balancing the cost and effectiveness of online WMP.

Level of Evidence: Level II (Cohort Study)

Rationale: The study retrospectively evaluates a workplace weight management program using the RE-AIM framework, making it a cohort study.

Spreckley, M., Judith de Lange, Seidell, J., & Halberstadt, J. (2023). Primary care-led weight-management intervention: qualitative insights into patient experiences at two-year follow-up. International Journal of Qualitative Studies on Health and Well-Being, 18(1). https://doi.org/10.1080/17482631.2023.2276576

Abstract:

Purpose: The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance.

Methods: A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series.

Results: We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family.

Conclusions: The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.

Level of Evidence: Level III (Qualitative Study)

Rationale: This study is based on qualitative interviews rather than quantitative data, placing it in Level III.

Level of Evidence: Level III (Qualitative Study)

Rationale: This study is based on qualitative interviews rather than quantitative data, placing it in Level III.

Suojanen, L-U., Ahola, A. J., Kupila, S., Korpela, R., & Pietiläinen, K. H. (2020). Effectiveness of a web-based real-life weight management program: Study design, methods, and participants’ baseline characteristics. Contemporary Clinical Trials Communications, 19, 100638. https://doi.org/10.1016/j.conctc.2020.100638

Abstract:

Obesity is an important public health concern with limited effective treatment options. Internet-based technologies offer a cost-effective means to treat obesity. However, most of the online programs have been of short duration, have focused on a limited number of treatment modalities, and have not utilized the potential of coaching as part of the intervention. In this paper, we present the design, methods and participants’ baseline characteristics in a real-life internet-based weight management program. Healthy Weight Coaching (HWC) is a 12-month web-based intervention for the management of obesity. The program is based on the Acceptance and Commitment Therapy and includes themes important for weight loss, including diet, physical activity, psychological factors, and sleep. In addition to the automated, interactive program, a personal coach is allocated to each participant. The participants are nationally enrolled through referrals from primary care, occupational health, hospitals, and private health care units. Adult individuals with BMI ≥25 kg/m2 without severe complications are included. On a weekly basis, participants submit their weight logs, training sessions, and lifestyle targets to the internet portal and are scheduled to have online discussions with their coaches 26 times over the course of a year. Questionnaires on lifestyle, diet, physical activity, psychological factors, sleep, and quality of life are completed at baseline, 3, 6, 9, and 12 months, and thereafter yearly until 5 years. Additionally, log data on the use of the service and discussions with the coach are collected. The main outcome is weight change from baseline to 12 months. Recruitment to the HWC is ongoing. Baseline data of the participants recruited between Oct 2016 and Mar 2019 (n = 1189) are provided. This research will bring insight into how internet-based technologies can be implemented in the virtual management of obesity.

Level of Evidence: Level II (Cohort Study)

Rationale: This research follows participants in an online weight management program and tracks outcomes over time without randomization.

Tate, D. F., Lutes, L. D., Bryant, M., Truesdale, K. P., Hatley, K. E., Griffiths, Z., Tang, T. S., Padgett, L. D., Pinto, A. M., Stevens, J., & Foster, G. D. (2022). Efficacy of a commercial weight management program compared with a do-it-yourself approach. JAMA Network Open, 5(8), e2226561. https://doi.org/10.1001/jamanetworkopen.2022.26561

Abstract:

Importance: Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated.

Objective: To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach.

Design, Setting, and Participants: This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions.

Interventions: A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss.

Main Outcomes and Measures: The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis.

Results: The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of −3.8 (4.1) kg vs −1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of −4.4 (7.3) kg vs −1.7 (7.3) kg among those in the DIY group. The mean difference between groups was −2.0 kg (97.5% CI, −2.9 to −1.1 kg) at 3 months (P < .001) and −2.6 kg (97.5% CI, −4.3 to −0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]).

Conclusions and Relevance: Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches.

Level of Evidence: Level I (Randomized Controlled Trial - RCT)

Rationale: This is a randomized clinical trial comparing a commercial weight management program with a do-it-yourself approach.