Combined Diet Physical Activity Intervention Effective at Reducing Obesity in Young Adults: A Critical Appraisal of Literature Review Methodology and Identified Studies

This critical appraisal evaluates the effectiveness of combined diet physical activity intervention for reducing obesity in young adults. The literature review methodology, search strategy, critical appraisal of identified studies, and ethical considerations are discussed. The identified studies are evaluated based on their aim, kind of study, place of study, ethical approval, sampling size, information gathering, key findings, strengths and weaknesses, and value of study. The study concludes with recommendations for future research.

Dissertation

TABLE OF CONTENTS
.........................................................................................................................................................1
LITERATURE REVIEW METHODOLGOY................................................................................3
Importance of public health decision..........................................................................................3
Literature review ........................................................................................................................3
Search strategy ...........................................................................................................................3
Critical appraisal.........................................................................................................................3
Discussing hierarchy and type of study......................................................................................4
CRITICAL APPRAISAL OF IDENTIFIED STUDIES.................................................................5
Article 1:......................................................................................................................................5
Article 2:......................................................................................................................................6
Article 3.......................................................................................................................................7
Article 4.......................................................................................................................................8
Article 5.......................................................................................................................................9
CONCLUSION..............................................................................................................................11
REFERENCES..............................................................................................................................12

LITERATURE REVIEW METHODOLGOY
Importance of public health decision
The importance of public health decision relating to policy, programmes, projects and
services. This is necessary to be evaluated because in case the research will not be conducted
with respect to the public health decision then this will be affecting the working of the whole
research (Snyder, 2019). hence, in the present case of researching on combined diet physical
activity intervention effective at reducing obesity in young adult the different articles have been
reviewed relating to the different published data. these different articles have been selected in
order to ensure that the proper critical analysis is being undertaken and over objective of the
study is being achieved.
Literature review
The literature review is being defined as the overview of the previously published work
relating to a specific topic. This involves the analysis of the different types of the work of various
authors and this will be improving the research outcome. Also the critical narrative literature
review is being referred to as the critical, comprehensive and the objective analysis relating to
the current knowledge over the topic being researched that is combined research on diet physical
activity for reducing obesity. in the present case, the research is being undertaken on the obesity
and overweight and different factors affecting it.
Search strategy
The PICO framework is being defined as the evidence- based practice in order frame and
answer health or clinical related question. The use of PICO framework is being implemented in
order to improve the conceptual clarity relating to the clinical problem. in accordance to the
PICO framework the research question is whether diet physical activity intervention is effective
at reducing the obesity within young adults or not. The search strategy is very important to be
analysed and used within the study. in the present case the use of keyword search strategy was
used and research was done using the keyword like OVRWEIGHT, OBESE, ADOLESCENCE
and other was used. along with this, different BOOLEAN operators were also used and this
included AND, OR and many others (Pandey and Pandey, 2021). The strength of using this was
that it assisted in searching the articles in better terms and this improved the working in better
terms. Along with this the inclusion criteria involved the articles present in English language

only and all the other articles in other language were excluded. Along with this articles beyond
2015 will not be undertaken. Also, the article which will be beyond 2015 will be excluded from
the study.
Critical appraisal.
From the particular study it can be mentioned that critical appraisal is one of the
significant pattern of gaining the information that is helpful in studying the highlighted subject
matter. This basically related with having systematic process which is process of systematic
examination of research that provides assistance in trustworthiness, value & relevance. The
particular critical appraisal has provided assistance in having the clarity about the aim, kind of
study, place of execution, ethical approval, information gathering, measurement style, sampling
size, key findings, strengths & weaknesses, value of research and its further implication. On the
basis of this it can be identified that critical appraisal of each article has given the ability to
understand its reliability & clarity in turn attaining crucial information for deriving reliable &
transparency of study so that effective outcomes can be achieved. With help of these , the
research related with combined diet physical activity interventions effective at reducing obesity
in young adults has become possible in effective manner. It has offered the measurement validity
that is shown by possessing effective utilization of techniques that are suitable for evaluating
selected samplings size. In the chosen study the validity and reliability involves spreading
questionnaire, using t test, etc. which has aided in gaining the consistent results in similar
situation. Generalisability indicates that is showing that demographic factors such as age, etc
characteristics possessing sample has been chosen that is showing corrective external & internal
validity.
Discussing hierarchy and type of study
Hierarchy of evidence in the current study involves that proper utilization of study type
has been done which has given corrective form of findings so that improvement actions can be
identified. In the research related to combined diet physical activity interventions effective at
reducing obesity in young adults proper form of findings has been exerted for assessing
improvement action. There are three different types of the research which involves random,
cross-sectional and cohort study. These are helpful in effectiveness of public health &
promotion interventions so that reliable measurement of selected sampling to get fair results.
Random sampling offers the benefits in public health study such as equal chance of selection,

easy way to data collect, less time-consuming. On the other side, no additional knowledge,
complex, monetary cost to process, etc. Cross sectional study has given advantage such as cheap,
quick, multi variable at same time, etc. in contrast to this, useless for determining cause, effect,
not suitable for evaluating behaviour.
Ethics and ethical review
Ethical consideration is highly important for the research as leads to get the ability to
understand study validity & reliability (Ngozwana, 2018). In the present study the researcher has
given emphasis on having approval from the suitable committee so ethical requirements can be
fulfilled. In this ethical requirement for completing the stuyd regarding combined diet physical
activity interventions effective at reducing obesity in young adults the various actions has been
taken. From the selected samplings size consent form has been signed for the voluntary
participation and reliable data collection through studying them. On the basis of this it can be
interpreted that particular research has given emphasis on gaining effective application of ethical
requirements so that higher valid & reliable study can be formulated.
CRITICAL APPRAISAL OF IDENTIFIED STUDIES
Article 1:
1
Aim : the main purpose of current study is to evaluate the effects of a multidisciplinary family
based lifestyle intervention to treat over weight obese children and adolescents.
2
Kind of the study: a quasi-experimental
(controlled) form of the study as two groups are used for gaining information for the purpose of
comparison (Manca and et.al., 2022).
3
Place of study: children & adolescent group were studied at Pediatric Clinic of the
local hospital
4
Ethical approval: in the current study there is ethical approval from the local ethics committee
for gaining the significant ability to accomplish the research in effective manner has become
possible for attaining specified aim. The parents’ informed

written consent to the lifestyle intervention has been taken.
5
Sampling and its size: Children & adolescent group were selected by having total sampling size
of 74. In this 43 are in children group which has 58.1% male and 41.9%
female that are possessing the age between 5-12. In the 31 are in adolescent group which
comprises 38.7% male and 61.3% female.
6
Information gathering: the measurements are made in anthropometric, nutrition habits and
physical performance. Which has helped in gathering informational. It is measured by using
using standard techniques such as WHTR, air displacement plethysmography, chronometer, etc
which is analyzed by SPSS, t-test of the anthropocentric measure, etc.
7
key findings from discussion: it is found that there is effectiveness in reducing cardiometabolic
risk
via having declination of WHTR and body composition can lead in obtaining the same. Change
in nutritional habits leads to have improvement in physical performance.
8
Strengths & weaknesses of study: strengthening areas higher level of focus on study, greater
flexibility, etc and limiting parts are lack of a reproducible
and standardized clinical model of intervention, lack of control group, etc.
9
Value of study and further study: there is improvement in health by exercising, changing in
nutrition pattern, etc. for further study eliminating lacking areas such as lack of control.
Article 2:
1
Aim : The main aim of the study is to ascertain influence of multi component
school based intervention constituted of modification regarding daily excise and psycho social
consultation on body status in overweight, adolescent and obese children.
2
Kind of the study: Randomized cross-sectional study
3

Place of study: Shantou city
4
Ethical approval: this is approved by the Shantou
Ethics Review Committee (SERC) and taken consent from conducted participants (DiMeglio,
Evans-Molina and Oram, , 2018).
5
Sampling and its size: this comprises 226 overweight students in which 41 have given consent
for study which involves 25 boys & 16 girls. This is basically from control, allocation baseline
and intervention school that are chosen from China and shantou city.
6
Information gathering: questionnaire has been spread among students and telephone follow up
has been done. The measurement has been exerted by Waist-to-hip ratio (WHR), WC, HC &
waist-to-
height ratio (WhtR). This is basically exerted by measuring these ratios, eights, etc so that
crucial information regarding the same can be gathered.
7
key findings from discussion: it is identified that lack of the diet and improper balance leads to
imbalance of the energy which basically causes the obesity. In addition to this, change in
lifestyle also leads to impact in obesity and more focus on behavioral change should be provided.
8
Strengths & weaknesses of study: Strengths comprises aware students, focused, feasible study,
etc. limitation involves in data analysis that involves lack of cooperative behavior of students ,
lack of consent lead to lower size sampling, etc.
9
Value of study and further study: the value of study involves higher focus on improving non
significant enhancement as it is considered to be not so serious of mental health. the large
sampling size for gaining detailed study in further research.
Article 3
1
The aim and objective of the present study was to analyse the effect of the life style
intervention program relating to diet and exercise over the Irisin and FGF 21 within adolescents

and children suffering from obesity and overweight. this is the major issue which the children
now- a- days are facing.
2
The kind of study which is undertaken is the evaluation study because in this the data
collected is being analysed and evaluated in order to attain the objectives of the study.
3
The data was collected from out- patient clinic for the prevention and management of
overweight and obesity in childhood. the data was gathered from 310 of children and
adolescents.
4
Yes, the approval was taken from Committee on the Ethics of Human Research of Aghia
Sophia children’s hospital.
5
The kind of participant involved within the study is 310 of children and adolescents and
the mean age of obese children was 10.7 and the overweight children was having the age of 10.3.
Along with this the height was 148.7 for obese and 143.5 was overweight.
6
For measuring the information gathered and to attain the objectives of the study the use
of multiple regression was performed for analysing the effect of changes within the
cardiometabolic risk factor and changes in irisin and FGF 21 concentration.
7
The key findings highlighted the fact that the total sample was 310 and this aged from 2-
18 years and the 162 were males and 148 were females (Karampatsou and et.al., 2021). The
results highlighted the fact that the clinical characteristic of the subject outlined that children
with obesity is having higher SBP and DBP.
8
The major strength of the study identified by the author was that the study is
multidisciplinary and personalised and intervention program was well designed. there was not
any limitation being identified within the study.
9

The value of research identified is that use of quantitative study is much beneficial and the
recommendation for future research is to include more qualitative study as well.
Article 4
1
The aim of the study was to analyse the effect of multidisciplinary lifestyle intervention
relating to obesity status and body composition and cardiometabolic risk marker among children
and adolescent with obesity.
2
The study undertaken within the present case was quasi- experimental intervention trial
with two active treatments.
3
For the study total 103 participant aging between six 16 years and these were recruited
for the intervention for Childhood and Adolescents Obesity via the activity and Nutrition.
4
The approval was taken from Hallym University Sacred Heart Hospital’s Institutional
Review Board.
5
Total of 103 participants were selected and out of this 63 were boys and 40 were girls and
their age was ranging between 6- 16.
6
For the measuring of the data different test were applied like the Shapiro- Wilk test was
applied for evaluating the normality of the data. also, the Pearson chi square test and Fisher exact
test was also applied
7
The key finding mentioned within the study was that 38.8 % was girls and out of them
34.0% were facing severe obesity and 80.6 % was having BMI >97th percentile for age and sex
(Seo and et.al., 2019).
8
The strength of the study was that all the protocol was followed and applied within the
practice. the limitation of the study was that there was short duration for the follow up of the
data.

9
The value identified from the study was that obesity is being affected by changes in the
different aspect. moreover, for better future working it is necessary that major emphasis is given
on the secondary data as well.
Article 5
1
The aim of this research is to measure the effects of solution focused approach and its
significance on nutrition exercise attitudes and behaviours of overweight obese adolescents.
 To analyse the concept of solution focused approach on nutrition.
 To develop the significance of exercise attitudes and nutrition on obese adolescents.
 To assess the behaviour of overweight obese adolescents its changes due to solution
focus approach.
2
This was a randomized controlled trial.
3
This study was done on 2016 in University of Cumhuriyet, Sivas, Turkey.
4
Yes, they did collect ethical approval from Approval was obtained from the Ethics
Committee of university clinical studies, along with consent from the participants.
5
The participants selected were adolescents that were aged between 12-13 years, and they
were not diagnosed with any metabolic disease.
6
The SFA interview technique implementation provided for overweight and obese
adolescents positively developed their nutrition-excessive attitudes in the 6-month period caused
by the weight (Akgul Gundogdu, N., Sevig, E. U. and Guler, N., 2018). The lifestyle of the
participants and the impacts of healthy nutrition and exercise on their behaviours.
7
The key finding in the discussion shows that results of increased healthy nutrition
exercise behaviours and attitude scores of overweight and obese adolescents after following the

intervention showed that the obese children were successful in healthy nutrition, exercise and
weight management points.
8
Limitation of the study was that it was unable to generalize external validity. Strength
was that it helps the overweight obese children in fighting their conditions.
9
The value of this research is that it helps the obese people in tackling their medical
situation. For the future research SFA interview technique can be used with large section of
participants.
Article 6
1
The objective of the article is to analyse the effect of novel mobile help intervention compared to
the multinational component behaviour with the changing program over the body mass index.
2
The study undertaken is the randomised controlled research.
3
The research was undertaken within the child obesity centre in Switzerland where in 41 youth
age 10 to 18 years was the sample.
4
The ethics approval was taken by the Cantonal Ethical Committee at St Gallen at Switzerland.
5
The kind of participant selected included the children belonging to 10 to 18 years of age and
average BMI of 28.8.
6
The information was gathered and measured with help of focus of graphical presentations. For
this box plot was being created with help of the data being gathered with help of questionnaire.
7
The key findings of the article included the fact that it can be stated that at the start of the
intervention the median BMI of the entire patient was 2.61 and it degree significantly in the Con
1 at T1 but not at T2.
8

The major strength of the current study is that it is randomised control design. This helps in
evaluating the data and much effective and Better manner. Along with this the limitation of the
study was that the sample size was small and because of this findings cannot be generalize to the
whole community.
9
The valuing identified from the research is that obesity needs to be managed in proper and
effective maner. Furthermore future research recommendation is to implement the study with
large sample size so that more relevant outcomes can be gethered.
CONCLUSION

REFERENCES
Books and Journals
Akgul Gundogdu, N., Sevig, E. U. and Guler, N., 2018. The effect of the solution‐focused
approach on nutrition–exercise attitudes and behaviours of overweight and obese
adolescents: Randomised controlled trial. Journal of clinical nursing. 27(7-8). pp.e1660-
e1672.
DiMeglio, L.A., Evans-Molina, C. and Oram, R.A., 2018. Type 1 diabetes. The
Lancet, 391(10138). pp.2449-2462.
Karampatsou, S. I. and et.al., 2021. The Effect of a Life-Style intervention program of diet and
exercise on irisin and FGF-21 concentrations in children and adolescents with overweight
and obesity. Nutrients. 13(4). p.1274.
Manca, P. and et.al., 2022. Variant allele frequency in baseline circulating tumour DNA to
measure tumour burden and to stratify outcomes in patients with RAS wild-type
metastatic colorectal cancer: a translational objective of the Valentino study. British
journal of cancer. 126(3). pp.449-455.
Ngozwana, N., 2018. Ethical dilemmas in qualitative research methodology: Researcher’s
reflections. International Journal of Educational Methodology. 4(1). pp.19-28.
Pandey, P. and Pandey, M. M., 2021. Research methodology tools and techniques. Bridge
Center.
Seo, Y. G. and et.al., 2019. The effect of a multidisciplinary lifestyle intervention on obesity
status, body composition, physical fitness, and cardiometabolic risk markers in children
and adolescents with obesity. Nutrients. 11(1). p.137.
Snyder, H., 2019. Literature review as a research methodology: An overview and
guidelines. Journal of business research. 104. pp.333-339.