CHAPTER ONE: INTRODUCTION
Due to such co-morbidities associated with obesity as diabetes, hypertension, angina, myocardial among others. Government institutions charged with health responsibilities are moving with urgency to resolve this complex issue. A Multidisciplinary Team Approach (MDT) has been proposed by NICE as the only plausible approach to the pandemic; its guidelines propose varying component approaches to the issue. In the same support, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines recommends change in behaviour, society’s lifestyle and eating habits coupled with other interventions such as surgery in management of the pandemic. In addition to SIGN recommendations, NICE includes other social and educational modifications towards obesity management (Chan et al 1994).
In UK, one of the countries hardest hit by the pandemic, Glasgow and Clyde Weight Management Service (GCWMS) features as the most prominent weight management program. This is a whole-system approach into weight management that makes employs knowledge on feeding habits, behavioural influences, therapy among others into helping obese or overweight individuals. It is an award-winning programme having been able to provide continuous pre and post weight management patients; it also allows medical institutions to monitors and assesses progress of the patients. According to SIGN (2010) and NICE (2006) guidelines, GCWMS satisfies their requirements since it follows an evidence based national guidelines of a multiple areas intervention.
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GCWMS aims to provide equitable and evidence-based prevention and/or treatment; it also focuses on morbid obesity to achieve weight loss that meets the NHS requirements. The program is divided into three stages/phases; the first phase comprises of physical, feeding, and other non-drug interventions. Pharmacotherapy starts in phase 2 on the occasion that phase 1 was ineffective in leading to a weight loss of over 5kgs. Then, phase three may involve surgery as per a patient’s choice. The GCWMS besides intervening on psychological and physical levels of obese and overweight individuals, it also preps patients who are due for surgery in phase 3.
1.2 Background Information
While the rise in obesity can be stated as a global issue in many European countries, the rate of increase in the UK is indeed higher and at an alarming rate. WHO and OECD data estimates indicate a consistently high rise in the UK’s obese population. National Health Surveys indicate that between 1993 and 2010, the percentage of adult population that was non-obese (with a BMI of 18.5 to 24.9) fell from 49.5% to 40.4% in women, and from 41% to 30.9% in men. Thus, a quarter of the UK’s population is overweight or obese and the situation is projected to become worse by 2030; the rate will hit 40% and then by 2050 the rate will double implying that over half of the country will be obese/overweight (Department of Health 2009).
Analysis of OECD countries indicates that UK is set to be the obese member if the trend continues. With the realization that this rise may influence its neighbours such as Scotland, the NHS, NICE and SIGN have been in continuous consultation and search for an antidote to the situation. They propose a whole system upon since reality points out that only a social change can cure the pandemic. Obesity issues have been known to be tied to lifestyle, cultural, and individual aspects (SIGN 2010).
Related to the issues of obesity and its related co-morbidities, the researcher proposes to assess the effectiveness of the GCWMS program. The researcher will review literature related to the issues of obesity and the complications related to it. The researcher also proposes to consider divergent opinions on assessment of weight loss programs by various scholarly articles. Lastly, the researcher proposes to collect information from different sources and systematically analyse it to answer the research questions.
1.3 Research Questions
1) What are the important factors in assessing a weight loss program?
2) How is obesity related to diabetes?
3) How obesity does affect a patient’s psychological well-being?
4) How does obesity influence Health Related Quality of Life indicators?
1.4 Recommendations for Further Research
The amount of literature in assessment of the aggregate components of a weight management program such as physical, dietary, psychological, and surgical abound. In contrast, there is scanty information on the effectiveness of specific intervention approach. It is particularly pronounced in the area of behavioural intervention in childhood obesity. The researcher therefore recommends replication of treatment procedures; this will aid in understanding whether a particular approach is beneficial or requires modification. Also, it will aid in assessing a weight loss program on a part issue other than aggregate. The understanding can largely contribute towards development of a new intervention program based on small components of other programs proven to be highly effective. In addition, in many weight loss programs rarely modify their interventions approaches. This study proposes an investment in identifying predictors of weight loss maintenance. It would ensure systematic review of a patient’s development, adoption of new approaches that would ensure retaining into the program, and would inform a need for modification of intervention.
CHAPTER TWO: LITERATURE REVIEW
2.1 Intervention Initiatives Assessment
The effectiveness of a weight loss program is indicated by its investment in area of reducing obesity in children (Epstein et al 1990). He postulates that timely intervention is critical if a weight loss program will sustain weight loss amongst 5-10 years old children. In a longitudinal study involving 5-10 years old children, Epstein et al (1990) showed results that a good program can lead to a weight loss of over 20%. Over 4.5 million children in the United Nations are obese, and this will significantly translate into adult obesity in a few years. Collins et al, (2006), states that the absence of an effective programme wills plunge the country into a medical disaster. In this effect and given the pressure on the NHS to offers guidance, NICE (2006) came up with the whole systems approach: it offers a guideline towards better eating habits, lifestyle change, and adoption of a behavioural change that encourages a physically active state.
Despite these efforts, Reilly (2006) opines that there is scanty proof of the effectiveness of some intervention strategies. He states that public and clinical responses have been slower than the scale of rise in the obesity pandemic. Thus, he concludes that there is little evidence towards assessing any weight loss intervention program. Flynn et al (2005), concurs with Reilly (2006) by stating that there is still inefficient response of many programs to wards children and teenagers with obesity. Also, he adds that assessment of weight loss programs fail to appreciate the lack of evidence in the paediatric obese cases. He concludes that there are poor evaluation mechanisms of the current intervention initiatives.
Brown and Summerbell (2004) offer significant guidance in evaluating the effectiveness of programs such as GCWMS. Their argument pertains to the structure of a program and how it comes into contact with the individuals requiring its service. They offer an example of a weight management program based in schools as effective since it would ensure maximum contact and continuous evaluation.
2.2 Obesity and Diabetes
The relationship between obesity and many morbid conditions is well documented. However, majority of these conditions appear uncommon in earlier stages of a child’s life. This disguise of little effect is evidence in studies by Dietz (1998) showing that 8% of 1-2 year old obese children become obese in adulthood. In addition, studies in the area of childhood obesity indicate that 80% of children with obesity are likely to carry it to adulthood. The reality being noted, perhaps the most disturbing news regarding a rise in a country’s obesity relates to its close relationship with chronic illnesses (Mokdad et al. 2003).
Type 2 diabetes is noted as the highest type of diabetes in prevalence; it takes the biggest share UK diabetic patients (Chan et al. 1994). Type 2 diabetes manifests through resistance to insulin which scores as a highly critical situation. It has not escaped this and many studies that while type 2 diabetes is on the rise in the UK, so is obesity. Eventhough clinicians have long known the relationship between the two, it large scale manifestation has been sufficient to cause an alarm. Therefore, studies show that the approach towards diabetes treatment must start from the approach towards reducing the rate of obesity in the country (Chan et al. 1994).
2.3 Obesity and Psychological Well-being
Enough evidence on the relationship between psychological disturbances of obese individuals is scanty despite an abundance of information with regards to obesity and physical inabilities. In an attempt to fill this gap, Hasler et al (2004) observed overweight individuals for psychiatric conditions. His studies indicate that overweight and obese individuals had high chances of developing depressive behaviour. Tuthill et al (2006) took a sample of some obese individuals enrolled in some weight management program. He observed their psychological functioning through administered test; he found out that 56% of the patients had high anxiety scores while 48% scored highly for depression. These results are in support of others by Wadden et al (2006), who found that obese individuals were more likely to display depressive symptoms. He proceeded to indicate that women were more predisposed to this than men. The issues of weight are likely to affect their education, they may not secure a marriage partner and regardless of better or equal mental aptitude they may receive lower remuneration. These studies conclude that any weight management program must foresee other external issues that obesity will impose on the individual and be forward seeing in order to be effective. The lack of this might lead to drop out from a program or regain of weight upon loss.
2.4 Effects of Obesity on Health Related Quality of Life (HRQOL)
The personnel in charge of weight management must understand how patients perceive themselves given their obese status. This perception is imperative since it creates the right frame of mind in the practitioner, they are therefore able to put down components that will effectively address the patients issues; this perceptions are referred to as HRQOL. Fontaine and Barofsky (2006) document the HRQOL perceptions of obese patients. Their research found out that as a patient BMI rose, so did her/his HRQOL perception go down. At the same time, their studies indicate that weight loss improves this perception among both overweight and obese individuals.
Though, despite this evidence, Maciejeski et al (2005) argues that there is lack of consistency on many studies in the area. This may be due to the use of a different HRQOL measure such as one centred on domain or another centred on wide range observation. Studies by Bowden et al (2008) found that that a patient who lost weight scored a significantly on improved HRQOL. This score was better on many patients despite some having not lost weight that was significant to meet the threshold that would shift them from obesity to overweight. Thus, they conclude that focus on HRQOL is important to obese individuals’ wellbeing to the greatest extents.
While assessment of weight loss program specific components is imperative, it is also critical to interrogate a programs ability to retain individuals who enrol to it in relationship to the HRQOL. Teixeira et al (2002) opine that individuals with poor HRQOL are more likely to drop out of a program. This observation is tied to other aspects of inability to sustain weight loss which may frustrate the patient. However, he also notes that self-esteem is a critical part of the HRQOL and weight loss; individuals with low self-esteem constitute the higher percentage of drop outs. They continue to argue that poor HRQOL, especially among women at the start of a program, lead to higher drop out from the weight loss program. However, it is imperative to appreciate that there may be a bidirectional relationship between obesity and HRQOL.
CHAPTER THREE: METHODOLOGY
3.1 Method of Data Collection
In this proposal, the researcher will systematically review literature related to obesity, weight loss programs and assessments to answer the research questions. The researcher will follow SIGN (2010) guidelines in assessment of the effectiveness of GCWMS program. The researcher will also employ analysis of data in the areas of childhood, adolescent and adult obesity to answer the research questions comprehensively.
3.2 Ethical Considerations
The researcher will seek the approval of a local research committee in charge with matters of ethics in medical research. Any private information or records meant to be private shall be kept as private and will be only used for the purpose of this research. Finally, the conduct of this study will be guided by the BPS Code of Ethics & Conduct.