Literature Review on Obesity Management for Geriatric Patients

This report is a nursing literature review focusing on obesity management for a 78-year-old patient, Frederic Arum, with a focus on overweight and weight loss. It analyzes four journal articles, examining effective interventions, including lifestyle changes like diet and exercise, for geriatric patients. The review highlights the benefits of combined diet and exercise, emphasizing healthy aging and the need for further research to establish evidence-based practices. It discusses agreements and disagreements with the case study, suggesting aerobic exercise and protein-rich diets for Frederic. The report concludes that healthy lifestyle interventions are crucial for weight loss and overall well-being in older adults, while acknowledging the need for more research to establish clear guidelines. The report also highlights the importance of restricted carbohydrate and increased protein intake to reduce the loss of lean body muscle and bone density.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The following paper is based on the case study of Frederic Arum who is 78 years old
and is suffering from obesity. The paper will focus on the highlighting effective interventions
for management of obesity. In doing so, the paper will focus on the central theme of over-
weight and weight-loss and will conducted critical analysis of four journal articles that
coincide with the scope of the paper. At the end, the essay will focus on the agreement and
disagreement that can be extracted from the paper in relation to the case study. The analysis
of the four papers will help to provide a proper understanding of the effective of healthy
lifestyle intervention on weight management and promotion of the concept of healthy aging
among the geriatric patients.
Authorship of the paper
All expertise and the affiliations of all the authors of the four selected paper, are well-
established. All the authors are registered under esteemed universities or scientific
institutions. The selection of the papers written by authors from esteemed institutions helps in
increasing the quality of the evidence used in structuring the paper (Harnad, 2017).
Research question and methodology
The study conducted by Batsis et al. (2016) aims to identify the interventions of
geriatric obesity in order to develop evidence-based clinical recommendations. The main
study design includes systematic review of the randomized control trial (RCT). Murad et al.
(2016) stated that the systematic review of the RCTs falls under level 1 of hierarchy of
evidences due to its low level of bias. Batsis et al. (2016) selected RCT papers that have
conducted their studies over older adults with mean age of 65 years and body mass index
(BMI) more than 30 kg/m2. The analysis of the results from the RCT study showed that

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behavioural weight-loss interventions involving pharmacological or procedural interventions,
lasting for more than 6 months help in reducing obesity among the older adults at low to
moderate level. Batsis et al. (2016) proposed for more well designed trials for establishment
of the evidence-based practice (EBP). One of the principal strength of the study is its study
design. Batsis et al. (2016) also used the review was done based on the papers that were
published since 2005 to 2016. The selection of the studies within the last 10 years added to its
final strength. The methodological quality of the study was conducted by two separate
reviewers and this further helped to reduce the chances of reviewer bias. The review done by
Jura and Kozak (2016) aimed towards bringing together the evidences associated with the
age-related change in the body fat composition and BMR (basal metabolic rate) and its
relation to the vicious cycle and development of the age related diseases. The review reported
that age related change in the body fat composition accelerates the vicious and thereby
accelerating the process of ageing. Though the review was informative, however, the review
failed to highlight any specific methodological structure that it used for the selection of the
papers. Moreover, the study is based on the inductive approach, that hypothesis was
previously selected even after the initiation of the study and thus resulting in the generation
of the observational bias. Locher et al. (2016) focused on the calorie restriction diet in
promoting weight-loss among the older adults the analysis of the results showed that calorie
restriction diet helps in promoting weight-loss among geriatric patients. One of the strength
of the study is review was conducted over the randomized control trial (RCT). However, the
sample size of the study is was inadequate as it selected only 7 RCT studies for the
conduction of the review. Certo et al. (2016) are of the opinion conducting review based on 7
studies might lead to the generation of biased results and thus unsuitable for the generation of
EBP in clinical research. Waters, Ward and Villareal (2013) focused: on whether the weight-
loss is achievable among the older adults under a safe and co-ordinate process. The study

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selected primary research papers and the final review was conducted over 10 articles.
Selection of the diverse primary studies, RCTs helped to the level of evidence of the overall
review and this can be considered as one of the strength of the study (Murad et al., 2016).
The study also used theme-based analysis of the selected papers and thus helping in a proper
representation of data interpretation (Maxwell, 2012). The result of the study, failed to
conclude any significant evidence towards safe weight-loss promoting interventions among
the older adults and proposed for further research on lifestyle interventions.
Key themes and concept of the research
None of the studies reviewed under the principle theme of over-weight and weight-
loss failed to provide any definite conclusion and all the studies proposed for further research
for the establishment of the evidence-based practice. However, one theme that can be
generated from the case study include
Combined diet and exercise components help in healthy ageing
The review of Batsis et al. (2017) stated that use of healthy diet plan along with
regular practice of the physical exercise helps in improving the physical performance and
improved quality of life while reducing the chances of muscle mass and none mass. Jura and
Kozak (2016) stated that practice of physical exercise among the older adults lead to loss in
the lean body mass promoting weight-loss. Loss in the lean body mass reduces mineralization
of the bones and thereby causing a decrease in the bone density (sarcopenia). Thus healthy
yet protein rich diet will help in gaining the lean body mass while helping to reduce the BMI.
This theme generated is further supported by the clinical trial conducted by Villareal et al.
(2017). The clinical trial reveled that aerobic and resistance exercise training will help in
physical functioning of the body by promoting weight-loss. The RCT review done by Locher
et al. (2016) showed that calorie restricted diet along with mild to moderate physical exercise

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helps in promoting weight loss over the older adults. The review of Waters, Ward and
Villareal (2013) also showed that change in the body weight, composition of body mass
along with dietary intake, physical exercise and insulin sensitivity following healthy lifestyle
intervention can be sustained for long term without contact. The main relationship with all
the studies that lead to the generation of the theme is, all the papers showed importance of the
healthy life-style interventions in promotion of healthy ageing and weight-loss however, none
of the studies was successful in establishment of the EBP guidelines for the older adults.
However, the pathophysiological understanding provided by the study conducted by Jura and
Kozak (2016) aging is associated with accumulation of several changes in the physiology of
the body. Obesity associated with aging increases the age of the cells leading to accelerated
aging. Gaining weight or obesity increases strain over the muscle mass and bones leading to
accelerated decaying of the bones. Aging also hampers the normal inflammatory process
hampering innate and adaptive immune response. Thus, overall it can be said that in order to
reduce the harmful effects of aging, the obesity or extra gain in weight must be regulated
strictly and this can be done through healthy lifestyle interventions.
Disagreement and agreement in literature
In relation to the literature and the case study, it can be stated that losing weight will
help to reduce the pressure over his joint. Frederic is having joint pain and this might be due
to gradually loss of bone density such that decrease in the body mass will be helpful for
improving his quality of life as it will help to conduct his activities of daily living. However,
weight training interventions for Frederic must be replaced with aerobic exercise training
because weight training might lead to dislocation of joints. Since Fredic is keen on reducing
weight, his calorie must be restricted as proposed by the GP. However, the restricted calorie

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intake must be imposed through restriction of carbohydrate in the diet plan while increasing
the protein intake in order to reduce the loss (Backx et al., 2016).
Thus overall the principal theme goes in favour of the case study as both physical
exercise and restricted calorie intake will be helpful in reducing body mass of Fedric.
Conclusion
Thus from the above analysis of the four review articles based on the theme over-
weight and weight-loss, it can be stated that healthy lifestyle interventions are found to
promote the concept of healthy aging. Health yet calorie restricted diet plan along with
regular practice of physical activity will be helpful in reducing extra-body mass of the older
adults and thereby helping to improve overall health and well-being. However, the calorie
restricted diet will include reduced or negligible consumption of carbohydrate while
increasing the protein intake. Increased protein intake helps to reduce the loss of the lean
body muscle and bone density. Weight-training exercise will-not be suitable for older adults
as it might lead to joint pain along with muscle constrains. Aerobic exercise will be suitable
for the older adults. However, all the articles that were reviewed in this paper recommended
by further research in order to establish EBP for the geriatric patients for the promotion of
weight-loss.

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References
Backx, E. M. P., Tieland, M., Borgonjen-van Den Berg, K. J., Claessen, P. R., Van Loon, L.
J. C., & De Groot, L. C. P. G. M. (2016). Protein intake and lean body mass
preservation during energy intake restriction in overweight older adults. International
Journal of Obesity, 40(2), 299.
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.
Certo, S. T., Busenbark, J. R., Woo, H. S., & Semadeni, M. (2016). Sample selection bias and
Heckman models in strategic management research. Strategic Management
Journal, 37(13), 2639-2657.
Harnad, S. (2017, May). Open access to peer-reviewed research through author/institution
self-archiving: maximizing research impact by maximizing online access. In Digital
Libraries (pp. 63-98). Routledge.
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.
Maxwell, J. A. (2012). Qualitative research design: An interactive approach (Vol. 41). Sage
publications.

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Murad, M. H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid. BMJ
Evidence-Based Medicine, 21(4), 125-127.
Tomkins, A., Zhang, M., & Heavlin, W. D. (2017). Reviewer bias in single-versus double-
blind peer review. Proceedings of the National Academy of Sciences, 114(48), 12708-
12713.
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.
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.