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Outline
Obesity is a global crisis that is posing as one of the major public health nightmares due to its exponential rise, especially among young adults (Jiang, Xai, Greiner, Lian & Rosengvist, 2005). Many experts attribute this fact to the increased consumption of carbonated drinks sweetened with sugar, which have a high glycaemic index and are energy-dense, coupled with the sedentary lifestyle among many families in recent years to be the major cause of the pandemic (Picot, Jones, Colquitt, Gospodarevskaya, Lovemen & Baxter, 2009). However, several pieces of evidence have shown that it can be controlled and managed effectively.
The problem is how to integrate such methods as exercise, behavioral changes, and a good diet for effective management. Again there are limited reviews on the impact and value of the integrated approach. This paper review exercise, behavioral therapy, and good dietary habit as non-surgical means of managing obesity to establish the possibility of reducing weight and eventual reduction in obesity pandemic among young adult.
Introduction
Obesity has become a global crisis and one of the main problems in the public health sector in recent years (Jiang, Xai, Greiner, Lian & Rosengvist, 2005). But of all obesity cases, young adults and children obesity rise to an epidemic level in recent years has posed the greatest threat to the general public hence concern to the healthcare providers, public health professionals, and society as a whole (Picot et al. 2009). In the United States, 17% of adolescents and children are defined as overweight, a condition that is directly associated with obesity prevalence (Jiang et al. 2005).
A United States data show that the number of adolescents with the body mass index of 95th percentile for ages 12 and above rose from 15.5% to 23.4% in particular ethnic minorities, while Europe shows overall overweight cases among adolescents increased from 8% to 21% (Northern Europe) and 17% to 23% (Southern Europe) (Jiang et al. 2005). Why is there an unprecedented rise in obesity pandemic among young adults? Many experts attribute this fact to the increased consumption of carbonated drinks sweetened with sugar, which have a high glycaemic index and are energy-dense, coupled with the sedentary lifestyle among many families in recent years (Picot et al. 2009; Jiang et al. 2005).
Statement of the problem
Many of the solo strategies to control obesity like frequent physical activities promotion, dietary modification as well reduction of sedentary lifestyle behaviors have not yielded much as earlier expected as the outcome has been considered insignificant. This has been a grave concern because obesity is linked to an increase in type 2 diabetes and hyperlipidemia among children and young adults (Savoye, Shaw, Dziura, Tamborlane, Rose, Guandalini, et al, 2007).
Background and significance of the problem
Even though several reviews have shown that surgery as an option has positive results than the conventional weight-loss strategies, especially for severe cases of overweight and obesity, the adverse complications (e.g. pulmonary embolism), side-effects (e.g. heartburn), and some death-related cases have raised concerns among stakeholders (Colquitt, Picot, Loveman & Clegg, 2009). The shortcomings of surgery as an option have led to the belief that exercise, combined with diet change or behavior therapy can offer the best alternative for the overall treatment of obesity and weight loss effectively and safely.
But the discrepancies for effective non-surgical obesity management are aggravated by inadequate review of best practices for treating obesity and weight, hence generating a knowledge gap that limits the long-term success of the treatment strategies. As Chanoine, Hampl, Jensen, Boldrin & Hauptman (2005) put it, long-term success of such therapy depends on the type of intervention used (p.2). This study is expected to influence the nursing practice to improve the overall health status of future adults and society as a whole, by reducing obesity prevalence. The medical cost for treating obesity and overweight is also likely to reduce once the result is adopted and practiced logically.
Statement of the Purpose of the Study
The purpose of this study would be to review the available literature on the best non-surgical procedures for managing obesity, with a critical analysis of their success and failures to ensure the best overall practice or a combination of practices are put in place for adoption.
Can obese young adults lose weight safely and effectively by exercise combined with diet change or behavior therapy? Weight loss is seen as the ultimate solution for reducing obesity not only in young adults but also among the entire population at risk of obesity. Young adults (14-21-year-olds) are prone to consumption of junk food and leading a sedentary lifestyle, dictated by the modern environment of little space for exercise.
Literature Review
Introduction
The study focus was backed by particular healthcare databases related to obesity and overweight cases. Cochrane Collaboration database was one of the main databases searched. Even though several materials were found in different languages, the search was limited to only peer-reviewed journals and articles written in English. The search terms used were obesity in young adult , obesity prevalence , obesity and overweight , obesity management in youth , and obesity prevention . Other databases searched with a similar procedure were BCERF Database, BRFSS Database, and ADOLEC.
Body of Review
Exercise for Weight Loss
In one of the studies to assess exercise as a means of achieving overweight loss in people with overweight or obesity, Shaw, Gennat, ORourke & Del Mar (2009) analyzed 43 different studies that involved 3476 participants and revealed exercise to have some impact on weight loss. The exercise was found to result in small weight loss when compared to non-treatment across all the studies, while exercise combined with diet control revealed better results (more weight loss) than diet alone (Shaw et al., 2006) Again, increased exercise intensity and frequency also increased weight loss magnitude, significantly reduced diastolic blood pressure, triglycerides as well as fasting glucose (Shaw et al., 2006).
Even though some data indicate that exercise results in very minimal and insignificant weight loss, many health experts believe that it confers very significant health befits to people with obesity and overweight (Shaw et al., 2009). Shaw et al. (2009) observe that there are several pieces of evidence that central fat accumulation has an adverse action on lipids that result in elevated triglycerides, and very-low-density lipoproteins and low levels of high-density lipoproteins (p.5).
It is therefore suggested that well-programmed exercise improves plasma lipoprotein status, particularly increasing high-density lipoproteins hence can be of particular benefit to persons with abdominal obesity even if it does not lead to weight loss (Picot et al., 2009). Furthermore, studies have shown that regular exercise reduces the chances of high blood pressure across all age groups compared to those who lead a sedentary lifestyle, irrespective of the weight of an individual (Shaw et al., 2009). According to a large cohort Harvard alumni study by Paffenbarger, cited by Shaw et al. (2009), those who participated in regular vigorous leisure activities had a 33% lower risk of developing hypertension and a 41% reduction in mortality from coronary heart disease for over 20 years.
Behavioral Therapy
Jiang, et al. (2005) studied the impact of family-based behavioral treatment and its feasibility in China and evaluate its impact. It was revealed that traditionally, Chinese like to show their love to their children through giving them food, hence the increase in overfeeding and overeating incidences among young adults. To help eliminate this cultural behavior, many healthcare experts have proposed that behavioral treatment would present the best alternative approach, especially family-based ones that have been noted to have significant benefits on the encouragement of good dietary practice.
It was noted that no parent or child and youth dropped out of the program for any reason, thus justifying this method of treatment to be feasible in China (Jiang, et al., 2005). Additionally, family behavior practice shows that there is the possibility of more success if the family environment is modified to support healthful dietary and exercise behavior (Dennison, Russo, Burdick & Jenkins, 2004).
In a longitudinal study in the United States in 2002, cited by Jiang et al. (2005), it was revealed that adolescent girls (between the ages of 9 and 19 years) had their obesity and overweight prevalence doubled, largely due to reduced involvement in physical activities. The study indicated that habitual activity scores declined considerably between the ages of 9 and 19 years, and significantly, the decline was more marked among girls who were comparatively inactive at the start of the study (Jiang et al., 2005). Jiang et al. (2005) therefore recommend that behavioral therapy is necessary to encourage continual activity among young adults (adolescents) to effectively control obesity.
Dietary Program
In a one-year randomized controlled study to compare the effects of the weight management program, one of the areas tested were the nutrition education component of the weight management program (James, Thomas, Cavan & Kerr, 2004). This program emphasized on non-diet approach that dwells on low-fat, and nutrient-dense food of moderate portion sizes: the canceling on nutrition involved decreasing the intake of juice, switching to diet beverages, switching to low-fat milk, and bringing lunch to school vs. choosing hot lunch (James et al., 2004).
The canceling exercise included decreasing sedentary lifestyle (e.g. TV watching, computer, and video games) and finding an activity that was enjoyable to the participants that enabled them to participate regularly in the bright bodies weight management group (James et al., 2004). The study revealed that simple education about health risks associated with obesity and overweight and routine canceling on diet and canceling are insufficient approaches to treating the pandemic since it did not lead to any reduction in BMI or body fat (James et al., 2004). In the study, cross-sectional data indicated that children between the ages of 9 and twelve with 95th percentile body weight are likely to gain approximate weight of between 5 to 7 kg towards their adolescent ages (James et al., 2004).
When Bright Bodies Program was developed to manage overweight in the low-income minority youth, with the provision of educational materials, techniques to modify behaviors, and exercise components designed for all members accessibility, there was a significant favorable impact on the lowering of BMI in two years (McMillan-Price, Petocz, Atkinson, ONeill, Samir, Steinbeck, 2006). There was no weight gain for the first year of study; successive years saw a 4% (3.7kg) reduction in body fat, and a modest fall in BMI (McMillan-Price et al., 2006). A view in comparison with the control group even showed a more impressive result, since even the physical fitness improved thus the declining chances of developing type2 diabetes in their young adult and adult stages of life (McMillan-Price et al., 2006).
Against the general belief that there is not much significance in the lifestyle change of overweight children and young adults, family-based programs that emphasize education, modification of behavior, as well as supervised exercise has the potential of lowering BMI, improving the composition of the body, and increase of insulin sensitivity (James et al., 2004).
There is no doubt the Bright Bodies program is successful partly because there is an existing frequent contact between families and the professional staff. As earlier stated, an increase in the consumption of carbonated drinks sweetened with sugar has been considered a contributory factor in the recent upsurge of body weight (James et al., 2004). In essence, children who consume one regular carbonated drink per day consume an excess of 10% more total energy intake than the non-consumers; and in the United Kingdom, more than 70% of young adults are said to consume carbonated drinks regularly (James et al., 2004).
In a study to determine if a school-based educational program aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in youth and children, it was established that the program could produce a modest reduction in the number of carbonated drinks consumed, consequently leading to a reduction in several overweight and obesity cases (James et al., 2004). Even though a recent Cochrane review indicated a lack of substantial evidence on the effectiveness of the interventions in this area that would allow for national strategies adoption or to help improve clinical practice, this result proved otherwise by giving somewhat positive justifiable results (James et al., 2004).
The elapse of 12 months saw both intervention and control groups showing some worthwhile noting results of increased water consumption, a scenario partly attributed to the promotion of drinking water during school to improve concentration (James et al., 2004).
Overweight and obesity in adolescents may lead to the decreased emotional and physical quality of life (Chanoine et al., 2005). Moreover, childhood obesity is likely to lead to morbidity and mortality in the mid-years or late years of an individual. This is backed by several long-term follow-up studies of school-going children and adolescents, which show that overweight children have a 15-fold higher risk of becoming overweight adults as compared to those children and young adults who have a normal weight (Chanoine et al., 2005).
Chanoine et al. (2005) therefore advise that effective weight management in children and adolescents is likely to have significant immediate results that would reflect better health for the future society. Even though limited studies are linking the benefits of pharmacotherapy, especially in children and young adults, it is predicted to have some significant role in the improvement of the result that is obtained with behavioral therapy (Wake, 2009). The only one known significant study of pharmacotherapy was a one-year study in obese adolescents on the use of anorexiants, which revealed that its effect on the central nervous system may not be appropriate for adolescents and children, despite its good showing in adults (Chanoine et al., 2005).
Several empirical studies have associated television viewing with increased obesity prevalence due to a high level of docility aggravated by the increased adiposity as a result of increased snacking and violence in play (Dennison, Russo, Burdick & Jenkins, 2004). In a study to develop and evaluate the interventions to reduce television viewing by preschool, the television and video watching intervention procedure, parents were asked to maintain a diary that they used to record the name and amount of time for each program and video their child/children watched for up to one week (Dennison et al., 2004).
The program staff led the weekly 20-minute interactive educational sessions, and to enforce the goals of the program, additional materials, the researchers provided more materials and the suggested classroom activities provided (Dennison et al., 2004). Each class was followed with each child being sent home with materials and activities to foster the discussion between the parents and children, encouraging children to seek parents support to complete the activities.
The results indicated that the habit of television viewing in preschool children is likely to continue with the child up to adolescents and even adulthood if not controlled (Dennison et al., 2004). In this result, children in the intervention and control group reduced television viewing by 3.1hours per week from 11.9 h/wk, and the total percentage of children watching television and videos for more than 2 hours per day decreased significantly from 33% to 18% (Dennison et al., 2004). This study indicates that family-based or preschool-based programs have a significant impact on children and adolescent obesity.
Summary of the evidence
Even though some studies have shown that Exercise was found to result in small weight loss when compared with no treatment across all the studies, exercise combined with diet control revealed better results (more weight loss) than diet alone (OBrien, Dixon, Laurie, Skinner, Proitto, McNeil, 2006).
Family behavior practice shows that there is the possibility of more success if the family environment is modified to support healthful dietary and exercise behavior. This is because as shown in one study highlighted above, habitual activity scores decline considerably between the ages of 9 and 19 years, and significantly, the declined was more markedly among girls who were comparatively inactive at the start of the study (Jiang et al., 2005). It is thus recommended that behavioral therapy is necessary to encourage continual activity among young adults (adolescents) to effectively control obesity among this age group (Jiang et al., 2005).
Good dietary behavior is hailed as one of the best ways to control obesity and overweight. The educational program that involves nutrition canceling on: decreasing the intake of juice, switching to diet beverages, switching to low-fat milk, and bringing lunch to school vs. choosing hot lunch showed better results may be of much benefits to obese young adults. This program, supported by other programs like TV watching reduction strategies, computer and video games is of crucial benefits if an alternative activity enjoyable to the participants is identified.
As highlighted above, it has been noted that simple education about health risks associated with obesity and overweight and routine canceling on diet is an insufficient approach to treating the epidemic since it does not lead to any reduction in BMI or body fat. In the study, cross-sectional data indicated that children between the ages of 9 and twelve with 95th percentile body weight are likely to gain approximate weight of between 5 to 7 kg every year, fueling speculation that this may proceed to young adulthood and adulthood ages (James et al., 2004).
Theoretical framework
Family behavior practice will act as a better behavioral therapy. This is because the family environment is modified to support healthful dietary and exercise behavior. It is thus possible that behavioral therapy is necessary to encourage continual activity among young adults (adolescents) to effectively control obesity among this age group. Furthermore, increased exercise intensity and frequency also increase weight loss magnitude, reduce diastolic blood pressure, triglycerides as well as fasting glucose.
A combination of exercise, behavioral therapy, and good dietary habit can lead to weight loss and eventual reduction in the obesity pandemic. The program should involve all stakeholders with a major focus on young adults to encourage sustainability. This is because a program designed with their contribution is likely to be more acceptable and enjoyable to them than programs designed for them. Again family and schools should also be at the forefront since they determine the environment for the young adult, which influences their behaviors and attitudes towards the activities.
Limitation
There is no substantial cost-benefit analysis to establish the value of the program about the cost factor, even though it would be of much importance to the health management organizations or practicing clinicians who would want to consider such a multifaceted program in managing overweight and obesity in young adults as well as children. Much study is, therefore, necessary to establish this knowledge gap.
Reference List
Chanoine, J.P., Hampl S., Jensen C., Boldrin M., Hauptman J. (2005). Effect of orlistat on weight and body composition in obese adolescents. JAMA, Vol. 293, No. 23, 2883.
Colquitt, J.L., Picot J., Loveman E., & Clegg A.J. (2009). Surgery for obesity. The Cochrane Database of Systematic Reviews, Issue 2. Art. No. CD003641. Web.
Dennison, B.A., Russo T. J., Burdick P.A., Jenkins P.L. (2004). An intervention to reduce television viewing by preschool children. Arch Pediatr. Adolesc. Med, 158: 170-176.
James, J., Thomas P., Cavan D., & Kerr D. (2004). Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomized controlled trial. BMJ. Web.
Jiang, J.X., Xia X. L., Greiner T., LIian G.L., & Rosenqvist. (2005). A two-year family based behavior treatment for obese children. Arch Dis Child; 90: 1235-1238. Web.
McMillan-Price, J., Petocz P., Atkinson F., ONeill K., Samir S., Steinbeck K., et al. (2006). Comparison of 4 diets of varying Glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults. Arch Intern Med, 166:1466-1475.
OBrien, P.E., Dixon J.B., Laurie C., Skinner S., Proitto J., McNeil J., et al. (2006). Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an Intensive medical Program. Ann Intern Med, 144: 625-633.
Picot, J., Jones J., Colquitt J.L., Gospodarevskaya E., Lovemen E., Baxter L., et al. (2009). The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technology Assess, 13(41):1-190, 215-357, iii-iv.
Savoye, M., Shaw M., Dziura J., Tamborlane W.V., Rose P., Guandalini C., et al. (2007). Effect of a weight management program on body composition and metabolic parameters in overweight children. American Medical Association, Vol. 297, No. 24.
Shaw, K. A., Gennat H.C., ORourke P., & Del Mar C. (2006). Exercise for overweight or obesity. The Cochrane Database of Systematic Review, Issue 4. Art. No. CD003817.
Wake, M. (2009). Issues in obesity monitoring, screening, and subsequent treatment. Curr Opin Pediatr. PMID: 19770765.
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