Evidence-Based Practice Model

EBP Evidence-based practice model EBP project issue: Obesity "The prevalence of obesity (BMI > 30) has been increasing; currently; at least 27% of the adult population is obese" (McTigue 2003: vii). Despite being one of the most pervasive health problems in modernity, there is relatively little information on obesity available in the annals of evidence-based medicine. This may be due to the fact that obesity is such a complex and multifactorial disease, without a clear etiology. Perfectly-controlled studies can be difficult to construct.

Many different factors can impact a person's ability to maintain a health BMI, spanning from genetics to culture to lifestyle to social and economic factors. A 2003 evidence-based review of existing studies of obesity in adults found in MEDLINE from January 1, 1994 to July 31, 2001 only found four meeting the relevant criteria of studying persons suffering from obesity. There were no RCT (randomized controlled trials, or the 'gold standard' of effective evidence-based medicine), only cohort studies. All of these evidence-based research studies revealed only modest results for a variety of obesity treatment programs.

It was found that "intensive counseling and behavioral treatment for obesity is effective in reducing mean weight by about 3 kg [approximately 6.6 lbs.] to 5 kg [approximately 11 lbs.] after 1 year. Pharmacotherapy with sibutramine or orlistat is also effective in reducing mean weight by about 3 to 5 kg. For people with BMI of 35 or greater, surgical therapy leads to dramatic reductions in weight of 20 kg or more" but contains many risks and is not indicated for all obese subjects (McTigue 2003: viii).

Overall, frequent screening, counseling, and consistent interventions were suggested as supported by all research studies. The greatest health benefits occurred in subjects able to lose more than modest amounts of weight. A similar 2004 evidence-based study of obesity added that the 'chronic' disease model rather than focusing on a specific weight loss goal is most productive although it similarly suggested frequent counseling and diet and exercise modifications as the cornerstones of obesity prevention (Orzano & Scott 2004).

Viewing obesity as a chronic disease was seen as more helpful than only focusing on the ultimate restoration of a lower BMI. Patients remain prone to 'relapse' and adapt old eating habits. Additionally, obesity itself can generate many chronic illnesses such as hypertension, type II diabetes, heart disease, and joint problems which do not entirely resolve themselves after a restoration of a normal body weight.

One problem with the stress upon calorie reduction and exercise as the solution to obesity, however, is that although this may be mathematically correct, it has proven to be relatively difficult for many subjects to adopt. Few can enact meaningful, permanent life changes. Not to become obese at all seems, statistically speaking, a better guarantee of long-term weight reduction, which is why many anti-obesity researchers stress the need to reduce the burgeoning obesity rate amongst children.

Another evidence-based study on obesity in children did yield some useful findings that indicate other factors that might foster obesity besides intake and expenditure of calories alone. For example, children who are breast-fed are considerably less likely to be obese than children who are bottle-fed. Initially, this was thought to possibly be due to correlation rather than causation, given that low-income children are more likely to be obese and less likely to be breast-fed.

But it was also found that "formula-fed infants grow faster than their breastfed counterparts, and many experts believe that this difference may have long-term health implications…with differences in formula composition likely having an important effect (New research findings, 2012, Medical News Net).

High levels of television of consumption; low levels of physical activity; lack of access to healthy foods and places to exercise; the side effects of increasingly common medications like antipsychotics and antidepressants; various health conditions like hypothyroidism and polycystic ovarian syndrome (PCOS); a lack of sleep; stress; smoking cessation (the rates of smoking have undergone a notable decrease in recent years); and age (the population as a whole in the developed world is aging) have all been linked to burgeoning obesity rates (New research findings, 2012, Medical News Net).

Thus, changing certain aspects of the environment and lifestyle practices, according to the evidence-based model, could enhance obesity reduction efforts. For example, adults and children who watch more than two hours of television a day are statistically more likely to be obese (What causes overweight and obesity, 2013, NIH). Actively reducing television consumption could thus have an effect on weight. Ultimately, treating obesity in children with early interventions and including at-risk as well as obese subjects in obesity reduction programs amongst adults remains.