NRSG266 Principles of Nursing: Elderly Weight Management Review

This nursing assignment focuses on the critical appraisal of four scholarly articles related to weight management interventions for elderly individuals, specifically in the case of Frederic Arum, a septuagenarian advised by his GP to lose weight and engage in weight-bearing exercises to alleviate joint pressure. The report synthesizes evidence from various studies, including systematic reviews and research articles, to determine the most effective approaches for geriatric obesity. The analysis covers interventions such as exercise, calorie restriction, and dietary modifications, and their impact on health outcomes, including physical function, bone and muscle mass, and the prevention of cardiovascular complications and diabetes mellitus. The assignment critically evaluates the methodologies, findings, and limitations of each study, highlighting the significance of lifestyle interventions, especially the combination of weight-bearing exercise and a low-calorie diet, for achieving and sustaining weight loss in this population. The conclusion emphasizes the importance of patient compliance with prescribed treatments to mitigate health risks associated with excess body weight.

Running head: NURSING ASSIGNMENT
Case scenario
Name of the Student
Name of the University
Author Note

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Introduction- Being obese or overweight refers to the presence of excess body fat that
is more than the amount of fat, which is considered optimally healthy. According to Williams
et al. (2015) accumulation of excess fat brings about movement and flexibility impairment
and also modifies the body appearance. The case involves a septuagenarian who has been
advised by the GP to start weight bearing exercise and lose weight in order to decrease
pressure on the joints. This essay will critically appraise four pieces of scholarly evidences,
supported by other literature in order to synthesise best evidences for the interventions that
have been suggested by the GP to Frederic Arum.
Body- Time and again it has been proved that loss of weight in individuals who are
obese or overweigh helps in decreasing health risks, thus increasing overall fitness, and
delaying the onset of cardiovascular complications and diabetes mellitus (Thiese et al. 2015).
In addition, management of weight has also been associated with a reduction in risks for high
blood pressure, thus lowering risks of morbidity. The systematic review by Batsis et al.
(2017) supported several geriatric obesity interventions and their role in improving health-
related quality of life and physical function among overweight individuals. The major
strength of this evidence can be accredited to its authorship, since all authors were members
and associates of healthcare department of reputed educational organisations. The research
question was based on identification of geriatric obesity interventions that were effective in
guiding different clinical recommendations. Aging is accompanied by modifications in
composition of the body. Fat free mass that is generally composed of skeletal muscle
demonstrates a reduction by as much as 40% from 20-70 years of age (Ambrosi et al., 2017).
However, with an increase in age, fat mass gets redistributed to the visceral components and
there occurs an imbalance between energy intake and expenditure. Owing to the fact that
there occurs a decrease in energy expenditure among the elderly people, with aging, the fat
mass increases, thus proving the significance of the research question (Bartolomeu et al.,

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2017). The researchers adopted the design of a secondary research. This was a correct
approach since it pooled in information from several investigations that were of a similar
design and analysed those medical literature in order to reach a consensus on the best kind of
treatment for the phenomenon under investigation. Furthermore, a summary of research
articles that were directly related to the research question acted as an important component of
evidence-based practice.
The researchers conducted a thorough search of scholarly evidences from different
electronic databases namely, Medline (PubMed), Web of Science, Cochrane Central Register
of Controlled Trials, EMBASE (Ovid), CINAHL, and PsycINFO (Proquest). Hence, they
adopted a correct search strategy that helped them develop an organised assembly of key
terms that facilitated extraction of accurate articles. In addition, usage of the Preferred
Reporting Items for Systematic Reviews and Meta‐Analyses criteria was another correct
approach since this minimum set of items are typically used for helping researchers report
systematic reviews based on risk-benefit analysis of particular interventions (Moher et al.,
2015). It was reported that more weight loss, increased quality of life, and reduction in bone
and muscle mass were detected, when exercise and dietary modifications were performed
together. Exercise alone enhanced physical function, however produced no impact on body
weight. Nonetheless, the authors stated that exclusion of observational study from the review,
publication bias, and exclusion of people aged between 60-64 years were major limitations
that might have reduced reliability of the findings.
The second research was conducted by Jura and Kozak (2016), where the latter was a
part of of Institute of Animal Reproduction and Food Research, Polish Academy of Science.
However, authorship of Jura could not be determined. The researchers tried to investigate
likenesses and underlying mechanisms associated to ageing and obesity. This was a
significant research problem owing to the fact that with an increase in proportion of people

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aged 65 years or more, the increase in prevalence of obese and overweight people also
increases (). Moreover, with a reduction in resting metabolic rate, physical activity decreases
and there is an upsurge in inactive time, accounting for decrease in aging-related energy
expenditure. The researchers did not identify any gap in literature in the introductory
sections, however, the lack of adequate evidence for the association between aging and
obesity formed the foundation of this research article. This article was also based on a
secondary research design that comprises of a summary, organisation and/or combination of
prevailing research, thus proving cost-effective and time saving (Frasca et al. 2016). Thus,
using already published information suggested the presence of a pre-established degree of
reliability and validity. However, some articles used in the review were out-of-date, thus
leading to bias in the results. A search strategy comprises of a well-developed plan that is
generally used for extracting pertinent articles, by using search terms, limiters and filters
(McGowan et al. 2016). Nonetheless, the authors did not mentioned the research
methodology, which was a major limitation. The results suggested that adipose tissue
inflammation among aged people leads to obesity and causes insulin resistance. In addition,
adiponectin generation and secretion were said to be repressed with the advancement of age
and obesity, besides the excess leptin production that causes insulin resistance. The findings
also highlighted lean mass reduction, upregulation of P53, and brown adipocyte induction as
a biomarker of ageing.
The authorship of the third review by Locher et al. (2016) was clearly elucidated and
most of the authors were members of the University of Alabama and/or the Wake Forest
School of Medicine, thus determining their contribution and accountability. The authors
developed three research aims namely, (i) providing current knowledge status about calorie
restriction recommendation for promoting weight loss, (ii) determining its risks and benefits,
and (iii) evaluating all outcomes. These were significant to the research question since caloric

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restriction refers to a dietary regimen that decreases calorie consumption without
inviting malnutrition or a decrease in important nutrients, and has often been associated with
a reduction in body weight (Most et al. 2017). This article design was also based on
secondary research, which was a correct approach since it was based on usage of primary
research sources for analysing the topic of interest. Owing to the fact that the researchers
wanted to determine the efficacy, risks, and outcomes of a particular intervention, adopting a
secondary research facilitated collection and summarisation of essential scholarly evidences.
While a detailed research methodology provides an overview of the techniques used for
analysing information such that similar findings can be obtained by other people on following
the steps, the authors failed to discuss the methodology that had been adopted (McGowan et
al. 2016). The findings suggested that when combined with exercise, calorie restriction
proves effective in reducing weight. Nonetheless, they were not able to analyse the risk-
benefit ratio for the intervention that acted as a major limitation.
The fourth review by Waters, Ward and Villareal (2013) demonstrated high
authorship since all three of them were associated with university and/or healthcare system of
New Zealand. The research question aimed to examine evidence concerning weight loss
intermediations with an emphasis on obese older adults, such as, caloric restriction and
exercise. Taking into consideration the various comorbidities that are associated with
overweight and obesity, such as, increase in mortality rate, glucose intolerance, insulin
resistance, hypertension, diabetes mellitus, sleep apnea, dyslipidemia, gall bladder disease,
hyperuricemia, arthritis, and cancer, the research question was extremely significant (Dhana
et al. 2016). Conducting a review was a good approach since it helped in summarising
information from several existing articles, thus increasing the reliability of the findings
(Walliman, 2017). A detailed information was provided by the authors about the literature
search method such as, the electronic databases selected and process of data synthesis, thus

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confirming the importance of having a well-formulated search strategy. They postulated that
healthy weight loss in this age group can be achieved through lifestyle interventions of up to
a one-year period. Most interventions reported reduction of bone mineral density and lean
body mass with weight loss. However, there was an unexpected increase in physical function
and muscle quality. However, one major limitation of the review was that it failed to
incorporate information from observational studies.
Therefore, an analysis of the articles discussed above suggest that it is essential for the
patient, Frederic Arum to show compliance to the treatment prescribed by the GP, which
predominantly focus on losing weight through weight lifting exercise and consumption of a
low calorie diet. Weight lifting exercise under the supervision of a trainer will help in weight
loss by affecting the balance of macronutrient. It will promote muscle strength gain and
muscle hypertrophy and will also facilitate body fat reduction by increasing the energy
expenditure (Villareal et al. 2017). In contrast, low calorie intake will also subject the body to
starvation, thus forcing the cells to burn the fat that has been accumulated, thereby reducing
the excess fat that has been accumulated in the body (Mozaffarian, 2016).
Conclusion- To conclude, the principal focus for the treatment of Frederic Arum is on
reducing the excess body weight, in order to prevent the onset of any comorbid health
conditions. Therefore, the chief treatment for obesity must comprise of physical exercise and
dieting. While making dietary modifications that focus on reduced calorie intake will help in
reducing weight over the short term, sustaining this weight loss might be habitually
challenging. Hence, it is essential for the patient to perform weight bearing exercise, besides
incorporating reduced food energy diet as a perpetual component of his lifestyle.

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References
Ambrosi, T. H., Scialdone, A., Graja, A., Gohlke, S., Jank, A. M., Bocian, C., ... & Saraiva,
L. R. (2017). Adipocyte accumulation in the bone marrow during obesity and aging
impairs stem cell-based hematopoietic and bone regeneration. Cell stem cell, 20(6),
771-784.
Bartolomeu, R. F., Barbosa, T. M., Morais, J. E., Lopes, V. P., Bragada, J. A., & Costa, M. J.
(2017). The aging influence on cardiorespiratory, metabolic, and energy expenditure
adaptations in head-out aquatic exercises: Differences between young and elderly
women. Women & health, 57(3), 377-391.
Batsis, J. A., Gill, L. E., Masutani, R. K., Adachi‐Mejia, A. M., Blunt, H. B., Bagley, P. J., ...
& Bartels, S. J. (2017). Weight loss interventions in older adults with obesity: a
systematic review of randomized controlled trials since 2005. Journal of the
American Geriatrics Society, 65(2), 257-268.
Dhana, K., Koolhaas, C. M., van Rossum, E. F., Ikram, M. A., Hofman, A., Kavousi, M., &
Franco, O. H. (2016). Metabolically healthy obesity and the risk of cardiovascular
disease in the elderly population. PloS one, 11(4), e0154273.
Frasca, D., Ferracci, F., Diaz, A., Romero, M., Lechner, S., & Blomberg, B. B. (2016).
Obesity decreases B cell responses in young and elderly individuals. Obesity, 24(3),
615-625.
Jura, M., & Kozak, L. P. (2016). Obesity and related consequences to ageing. Age, 38(1), 23.
Locher, J. L., Goldsby, T. U., Goss, A. M., Kilgore, M. L., Gower, B., & Ard, J. D. (2016).
Calorie restriction in overweight older adults: Do benefits exceed potential
risks?. Experimental gerontology, 86, 4-13.

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McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C.
(2016). PRESS peer review of electronic search strategies: 2015 guideline
statement. Journal of clinical epidemiology, 75, 40-46.
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L.
A. (2015). Preferred reporting items for systematic review and meta-analysis
protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1.
Most, J., Tosti, V., Redman, L. M., & Fontana, L. (2017). Calorie restriction in humans: an
update. Ageing research reviews, 39, 36-45.
Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and
obesity: a comprehensive review. Circulation, 133(2), 187-225.
Thiese, M. S., Moffitt, G., Hanowski, R. J., Kales, S. N., Porter, R. J., & Hegmann, K. T.
(2015). Commercial driver medical examinations: prevalence of obesity,
comorbidities, and certification outcomes. Journal of occupational and environmental
medicine, 57(6), 659.
Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., ... &
Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older
adults. New England Journal of Medicine, 376(20), 1943-1955.
Walliman, N. (2017). Research methods: The basics. Routledge.
Waters, D. L., Ward, A. L., & Villareal, D. T. (2013). Weight loss in obese adults 65 years
and older: a review of the controversy. Experimental gerontology, 48(10), 1054-1061.
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015).
Overweight and obesity: prevalence, consequences, and causes of a growing public
health problem. Current obesity reports, 4(3), 363-370.

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Summary table
Research
Theoreti
cal Methods: Major
Limitati
ons,
Conclusi
ons
Implicat
ions Themes Other
Auth
or, question;
framewo
rk sample,
Finding
s gaps
for
future
that
emerge
impor
tant
date rationale study
researc
h & issues
type, etc. practice
To
recognise
geriatric
obesity
intermediat
ions for
clinical
recommen
dation.
Based on
high
prevalence
of obesity
among
older
adults.
The Heal
thy
Ageing
Model
Systematic
review/sec
ondary
research
Exercise
alone
does not
bring
about
weight
loss
Absence
of
observat
ional
study,
publicati
on bias,
and lack
of older
adults
aged 60-
65 years
Combined
exercise
and
dietary
componen
ts help in
reducing
weight,
and
enhancing
quality of
life and
physical
function
Encoura
ging the
patient
to
follow
these
two
intervent
ions will
help in
weight
loss
(i)
exercise
(ii)
dietary
modific
ation NA
Batsis
et al.
To
recognise
The Heal
thy
Systematic
review/sec
Adipose
tissue
No
evidence
Age- Efforts
need to
(i)
adipocy
NA

9NURSING ASSIGNMENT
(2017
)
resemblanc
es
underlying
mechanism
s
associated
to both
ageing and
obesity.
Obesity
amid the
elderly is a
grave
concern Ageing
Model
ondary
research
generati
on,
adipone
ctin
secretio
n, leptin
producti
on were
associat
ed with
both old
age and
obesity
s from
animal
studies
associated
vicissitud
es in
distributio
n of body
fat and its
metabolis
m are
important
factors
that
hasten the
ageing
progressio
n and the
commenc
ement of
age-
related
illnesses.
be taken
to
address
the
factors
for
increasin
g life
expectan
cy of
older
adults
te
biology
Loc
Jura
To explore
the effects
The Heal
thy
Systematic
review/sec
Calorie
restricti
No risk-
benefit
Calorie
constraint
Older
adults
i)
exercise
NA

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and
Koza
k
(2016
)her et
al.
(2016
)
of calorie
restriction
for
promoting
weight loss
High
proportion
of older
adults are
overweight
and obese
Ageing
Model
ondary
research
on,
together
with
exercise
,
reduces
weight
analysis,
different
intervent
ion
compon
ents,
differen
ce in
time,
variation
in
outcome
, disease
burden
and
drop-out
rate
provides
some
advantage
,
particularl
y with
regards to
reduction
in weight
and fat
mass
must be
encoura
ged to
make
lifestyle
modifica
tions
(ii)
dietary
modific
ation
Water
s,
Ward
and
Villar
eal
(2013
)
To
methodical
ly
scrutinise
the
evidence
concerning
weight loss
The Heal
thy
Ageing
Model
Systematic
review/sec
ondary
research
Healthy
weight
reductio
n in old
age can
be
attained
through
No
observat
ional
study
Calorie
restriction
and
exercise
are able to
reduce
excess fat
among
Older
adults
must be
encoura
ged to
make
lifestyle
modifica
i)
exercise
(ii)
dietary
modific
ation
NA

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interventio
ns for
obese older
adults
Obesity in
older
adults is
universal
and leads
to negative
health
outcomes
lifestyle
interven
tions
older
adults,
and also
improves
their
physical
function
and
muscle
quality tions

Running head: NURSING ASSIGNMENT