Diet and Healthy Lifestyle vs. Bariatric Surgery

Problem Identification

The issue of obesity has become more prevalent in the context of modern global medicine. According to Bachler, Papamargaritis, Bueter, and le Roux (2013), in the past ten years, the prevalence of obesity has tripled and is currently affecting up to 35% of the population around the globe (p. 1). Furthermore, obesity causes major physical limitations in some patients that are unable to increase their activity even after surgical interventions like bariatric surgery. Despite the increased amount of research on the positive outcomes of bariatric surgery as well as post-surgery dieting, there is a lack of information on how obese patients can increase their chances of losing weight.

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The problem at hand is associated with the educational deficit about the comparison of a healthy diet and lifestyle change outcomes with the results of bariatric surgery. Bariatric surgery, as well as strict dieting before and after bariatric surgery, have already proven to be successful; thus, there is a need for further research on whether diet and improved lifestyle changes are more effective within a year period.

The current nursing environment is greatly challenged by the increased attention to care for obese patients that suffer from limited physical activity. Apart from the overall decrease in physical activity, obesity greatly contributes to the posture deficits, increased risk of falling, functional decline, as well as alterations in the spatiotemporal gait parameters, and high metabolic cost of walking (Pataky, Armand, Muller-Pinget, Golay, & Allet, 2014, p. 56).

Because obesity causes some serious physical limitations for some individuals, it is crucial to explore alternative methods of weight loss such as diet, lifestyle changes, and bariatric surgery before engaging in increased physical activity. As seen from the critical appraisal of evidence presented in the next chapter, there is a lot of research dedicated to the positive effects of extreme dieting and exercise to prepare for bariatric surgery and increase positive outcomes after the surgery.

However, there is a significant educational deficit in comparing diet interventions and lifestyle changes for obese individuals in comparison with bariatric surgery. Therefore, the critical appraisal of evidence will focus on the already existing research on the issue to find ways to incorporate it into the current research topic. It is important to mention that the issue of obesity that restricts physical activity is of great gravity regarding the current state of global health.

The proposed solution for addressing the issue of activity limitations will consist of two parts incorporating the dieting interventions and lifestyle changes in comparison with bariatric surgery. It would be effective for comparing one group of patients that implemented diet changes and lifestyle education and another group of patients that went through bariatric surgery within a period of one year. The expected result of the research will complement the already existing research that bariatric surgery is more effective in comparison with diet and lifestyle changes in the short-term; however, lifestyle changes combined with diet changes can be more effective in the long-term.

Overall, the research will focus on a variety of factors that influence the decision to pursue bariatric surgery, including psychological implications, to see whether the expectations of patients were fulfilled in the course of the research. It is important to investigate the psychological implication because they also contribute to the success of an intervention, whether lifestyle or surgical.

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Theory Incorporation

Because the research topic and the PICOT question greatly relate to the concept of self-care, Dorothea Orem’s Self-Care Theory was selected as the basis for the study. Orem’s theory is effective in describing a framework where a nurse assists a patient with maintaining an appropriate degree of self-care. The appropriate degree of care should be consistent with a degree to which a patient is either able or unable to fulfill his or her self-care needs (Sitzman & Eichelberger, 2011, p. 96).

The theory includes a variety of nursing care concepts targeted at explaining how nurses can aid patients in achieving the optimal degree of self-care. When it comes to the research topic at hand, there is a noticeable self-care deficit among obese patients with impaired physical activity since they are incapable of providing efficient and continuous self-care that will make a difference in the process of losing weight (Gonzalo, 2011, para. 6). Therefore, Dorothea Orem’s Self-Care Theory will be effectively incorporated into the proposed solution because of the need for effective self-care management when it comes to weight loss in obese patients.

The proposed theory will work with the solution since some obese patients with physical limitations require extra assistance in fulfilling the self-care needs. Nursing personnel can play the role of personal assistants when it comes to physical activity as well as teachers and educators so that patients will be able to learn more about how can lifestyle changes can be effectively implemented into the process of self-care. Preparation for bariatric surgery will also be accompanied by nurses’ assistance because the process requires some preparations regarding achieving optimal pre-surgery weight.

Critical Appraisal of Evidence

  1. The study was conducted because of the lack of quantitative research on the non-surgical alternatives that can be applied to obese patients. The sample size for the study included 206 participants, out of which 179 patients completed the study. The measurements of the major variables were valid and reliable; they included the measurements of the MBI, comorbidities, differences in weight loss, and LDL, HDL cholesterol levels. The data were analyzed at baseline and one year period. In the course of the study, no untoward events had been reported. The results fit with the previous research by providing a new perspective on dealing with morbid obesity. The research offered a conclusion that despite bariatric surgery is effective; lifestyle interventions could also be applied.
  2. The study was conducted due to the lack of information about the psychological background for maintaining weight loss after bariatric surgery. The sample size included 264 patients. The measurements of major variables were reliable and included socio-demographics, family obesity indices, unhealthy eating habits, alcohol consumption, etc. The data were analyzed with the analysis of covariance and multiple logistic regression. The untoward events during the study included some episodes of binge eating. The study provided extensive information on the psychological characteristics of patients scheduled for bariatric surgery. The study gave ground for future studies on exploring interventions for patients that went through bariatric surgery.
  3. The study was conducted due to the increased interest in surgical interventions improving major cardiovascular diseases associated with obesity. The sample size included 37 patients. The measurements of the major variables were reliable and included BMI and LV size, and mass. The data was analyzed through the performed echocardiography before and after and before one year of surgery. There were no untoward events documented in the course of the study. The results of the study added new information to the existing research on the topic of cardiovascular morbidities associated with obesity. The research means that bariatric surgery can significantly improve LV function and structure in patients with obesity.
  4. The studies contained in the review were randomized control trials and observational studies. The review included a description of inclusion criteria and search strategy; the reviewed articles were identified with the use of the Boolean keywords combinations. The results were not consistent across studies; furthermore, the research used aggregate data for weight outcomes and typed two diabetes mellitus remissions. After screening and analysis, 17 articles were eligible for assessment. The results of the review were presented in a graph. The results will assist in caring for other patients through the evidence that supported the effectiveness of bariatric surgery in comparison with bariatric surgery regarding weight loss promotion.
  5. The results of the study were trustworthy; the implications of the research were stated and related to the behavioral and self-management interventions. The effect on the reader was significant since the results indicated various challenges associated with obesity. The approach of the study combined Photovoice methods accompanied by in-depth interviews and triangulating photography. The significance of the study is explicit since it addressed the issue of unrealistic expectations associated with postoperative outcomes. The methods of data collection were clear and were repeated until no new themes and issues appeared from the analysis. The results of the study were presented in the form of quotes from patients and a table depicting patients’ experiences regarding the pre-surgery services.
  6. The results of the research were trustworthy because of the peer debriefing and prolonged discussion of the study. The implications were stated and associated with exploring the post-bariatric surgery patients’ experiences. The results of the study coincide with the effect on the reader: bariatric surgery does not fix all issues associated with extreme obesity. The study approach was identified as qualitative, aiming to study the effects and meanings of bariatric experience and providing in-depth information to future patients. The sampling strategy was clearly guided by the study needs and implied purposeful convenience sampling. The overall results were presented in the form of categories and specific excerpts from interviews with patients. The results of the studies concluded that bariatric surgery was not a quick fix and required a lifelong and lifestyle change for sustainability.
  7. The results of the study are trustworthy due to the planned recruitment process and in-depth analysis of every study participant. The results of the study indicated that the participants would go through the surgery again regardless of their emotional experience due to the positive outcomes. The significance of the study was explicitly stated as adding a new bulk of information to the existing body of studies on the topic of the psychological impact of bariatric surgery. The sampling strategy was clear and was identified as convenience sampling. The data analysis and collection techniques were clearly described as the phenomenological research method. The specific findings were presented in separate chapters that included the recruitment techniques and themes identified.
  8. The results of the research were credible and valid and included the identification of inequity as a limitation to bariatric surgery access; however, the implications of the research were not clearly stated by the authors. The results of the study identified the excited emotions of the bariatric surgery patients before the surgery, although the waiting period was described as frustrating and stressful. Furthermore, the researchers identified anger as the emotion exhibited towards the health care system if the waiting time was too long. Theoretical sampling was implemented in the process of data collection and analysis for further data testing. The results of the study will help with dealing with frustration and anger when it comes to awaiting bariatric surgery.
  9. The results of the research were valid and highlighted the major challenges associated with the self-management processes in patients pre-and post-bariatric surgery. The results across studies were not consistent due to the variety of methods used for treatment adherence in bariatric surgery. Aggregate data on patients was used in the research analysis. The results of the study related to the conclusion that the long-term success of bariatric surgeries depends on a system of actions, including follow-ups, dietary changes, exercising routines, as well as vitamin supplementation. Therefore, the results of the study will greatly benefit the medical practice because they provided a unified framework for sustaining the results of bariatric surgery.
  10. The study was done due to the lack of research on evaluating the efficacy of the low-energy diet lasting from seven to eleven weeks before bariatric surgery. The sample size included two randomized groups scheduled for surgery at different weeks. The measurements of major variables were reliable and included anthropometric measurables. The gathered data was statistically analyzed through the R version. The efficacy of low-energy diets was modeled with the usage of the linear mixed model. Despite some side effects, no untoward events were reported in the conduct of the study. The results of the study provided in-depth information on that preoperative weight can be reduced by 8% through a low-energy diet.
  11. The study was done due to the lack of data on the reduction of visceral obesity with the help of a preoperative diet. The sample size of the study included forty participants. The measurements of the major variables were valid and included patients; weight, and fat thickness. The data was analyzed by measuring the major variables and comparing them as the study proceeded. The research did not report any untoward events during the conduct of the study. The results of the study coincide with the previous research that suggested that a restrictive diet could reduce visceral adiposity in pre-surgical patients.
  12. The study was done due to the increased attention to the effects of bariatric surgery on bowel habits. The sample size included twenty-six patients. The measurements of major variables were valid and reliable and included dietary fiber intake, a frequency of bowel motions, etc. For diet assessment, the study used a validated food frequency questionnaire. They were no untoward events reported during the conduct of the study. The study results presented a new take on the decrease of bowel motion frequency after bariatric surgery in obese patients. The research provided a framework for future studies on how the issue can be resolved.
  13. The study was conducted because of the need to explore the necessity of physical activity to increase weight loss after bariatric surgery. The study assessed and reviewed randomized control trials with regards to increased physical activity after bariatric surgery. The relevant data were collected from various research to find common themes and results. The population of the focus coincided with the population in the review and included the general adult population. The study concluded that physical activity counseling should be tailored according to the outcomes of the bariatric surgery in individual patients.
  14. The results of the review were valid and related to the increased physical function after bariatric surgery. The review included changes in physical activity among patients in a total of fifty studies. The results of the studies were consistent across studies and suggested that physical activity increases positive outcomes of bariatric surgery. Furthermore, the studies indicated a significant increase in physical activity of low intensities after six months of the surgery and the reduction of vigorous physical activity in patients. In the analysis, researchers used aggregate data for the patient population.
  15. The study was done due to the lack of research between psychological factors and nutrient adequacy in patients after bariatric surgery. The sample size included 43 subjects, including men and women. The measurements of major variables were valid and reliable included overall weight loss rates, preoperative and postoperative weight. The gathered data were analyzed with the use of SPSS with a level of statistical significance of 0.5. There were no untoward events reported in the conduct of the study. The results of the study identified tight connections between psychological factors and nutrient adequacy in 74.5%, such as binge eating and depression. Despite this, 95.3% of study participants reported positive peer relationships.

References

Afshar, S., Kelly, S., Seymour, K., Woodcock, S., Werner, A., & Mathers, J. (2016). The effects of bariatric procedures on bowel habit. Web.

Bachler, T., Papamargaritis, D., Bueter, M., & le Roux, C. (2013). Treatment of morbid obesity: Intensive lifestyle intervention vs. bariatric surgery. Surgery Curr Res, 3(5), 1-5.

Cleveland, E., Peirce, G., Brown, S., Freemyer, J., Rice, W., Lee, L., Coviello, & Davis, K. (2016). A short-duration restrictive diet reduces visceral adiposity in the morbidly obese surgical patient. Am J Surg, 16. Web.

Geraci, A., Brunt, A., & Marihart, C. (2014). The work behind weight-loss surgery: A qualitative analysis of food intake after the first two years post-op. ISRN Obes, 2014, 1-6.

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Gonzalo, A. (2011). Dorothea E. Orem. The self-care deficit nursing theory. Web.

Gregory, D., Newhook, J., & Twells, L. (2013). Patients’ perceptions of waiting for bariatric surgery: A qualitative study. Int J Equity Health, 12(86), 1-11.

Hall, D. (2010). A qualitative study of bariatric patients and their social and emotional experiences after surgery. Walden University. Web.

Herring, L., Stevinson, C., Davies, M., Biddle, S., Sutton, C., Bowrey, D., & Carter, P. (2016). Changes in physical activity behavior and physical function after bariatric surgery: A systematic review and meta-analysis. Obes Rev, 17(3), 250-261.

Homer, C., Todd, A., Thompson, A., Allmark, P., & Goyder, E. (2016). Expectations and patients’ experiences of obesity prior to bariatric surgery: A qualitative study. BMJ Open 6(2), 1-11.

Hood, M., Corsica, J., Bradley, L., Wilson, R., Chirinos, D., & Vivo, A. (2016). Managing severe obesity: Understanding and improving treatment adherence in bariatric surgery. Web.

King, W., & Bond, D. (2014). The importance of pre and postoperative physical activity counseling in bariatric surgery. Exerc Sport Sci Rev, 41(1), 26-35.

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Kovalam, I., Bergh, I., von Soest, T., Rosenvinge, J., Johnsen, T., Martinsen, E., Mala, T., & Kristinsson, J. (2015). A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity. BMC Obes, 3(6), 1-11.

Martins, C., Strommen, M., Stavne, O., Nossum, R., Marvik, R., & Kusleng, B. (2011). Bariatric surgery versus lifestyle interventions for morbid obesity – changes in body weight, risk factors, and comorbidities at one year. Obes Surg, 21(7), 841-849.

Nielsen, L., Nielsen, M., Schmidt, J., Pedersen, S., & Sjodin, A. (2016). Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery. J Nutr Sci, 5(22), 1-7.

Ribaric, G., Buchwald, J., McGlennon, T. (2014). Diabetes and weight in comparative studies of bariatric surgery vs. conventional medical therapy: A systematic review and meta-analysis. Obes Surg, 24(3), 437-455.

Shin, S., Lee, Y., Heo, Y., Park, S., Kwon, S., Woo, S., Park, K., & Kwan, J. (2016). Beneficial effects of bariatric surgery on cardiac structure and function in obesity. Obes Surg, 26(220), 1-6.

Sitzman, K., & Eichelberger, L. (2011). Understanding the works of nurse theorists: A creative beginning (2nd ed.). Sudbury, MA: Jones and Bartlett Learning.

Vanoh, D., Shahar, S., & Mahmood, N. (2015). Association between nutrient adequacy and psychological factors with an overall rate of weight loss after bariatric surgery. Asia Pac J Clin Nutr, 24(4), 610-619.

Pataky, Z., Armand, S., Muller-Pinget, S., Golay, A., & Allet, L. (2014). Effects of obesity on functional capacity. Obesity, 22(1), 56-62.

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