Integrative Literature Review, Research Paper Example

Obesity has been an ever-increasing dilemma in the United States since the 1980s (Ogden, Yanovski, Carroll & Flegal, 2007). According to HealthyPeople.gov (2013), recent emphasis towards addressing obesity in children has shown improvement, but the adults in the country are still suffering from this issue and the numbers are increasing. The prevalence of obesity in the US exceeds 30% in most age and gender groups: the only exceptions are men from 20 to 39 years of age (Flegal, Carroll, Ogden & Curtin, 2010, p. 235). Obesity affects all races, education, income, and geographic categories. There is a higher prevalence in non-Hispanic black women (49.6%) as compared to non-Hispanic white women (35.5%) (Flegal, Carroll, Ogden & Curtin, 2010). Hispanic women also have a high prevalence of obesity, more than non-Hispanic whites (Ogden, Carroll, McDowell & Flegal, 2007). In respect of gender, the prevalence of overweight and obesity in men is 68.0%, whereas the numbers are 72.3% for women (Flegal, Carroll, Ogden, & Curtin, 2010).

According to the CDC (2012, p. 278) in 1997-1998 7.8% of the North Carolina population did not receive medical care due to the cost. The number remained the same in 2000-2001 at 7.8%, but made a significant increase to 12% in 2009-2010 (National Center for Health Statistics, 2012, p. 278). The numbers for prescription drug data showed 4.0% could not afford prescribed medications and went without it (National Center for Health Statistics, 2012, p. 278). This statistic increased to 6.0% in 2001-2002 and up to 9.1% in 2009-2010 (National Center for Health Statistics, 2012, p. 278). Drug prescription is important because there are some drugs that activate fat hormones and this increases obesity among individuals. This lack of regular visits for preventative care increases the costs to treat chronic or serious illnesses left untreated for too long.

The focus has been on increasing the amount of adults at a healthy weight and reducing the proportion of adults who are obese. However, the research from the CDC (2012) found that a large number of individuals overestimate their height and underestimate their weight, and when reporting their weight, height, and subsequent BMI, the numbers are wrong. When attempting to address weight loss many people use their false measurements and; therefore, their calorie intakes are not suitable for weight loss.

The subject of obesity in adults over 20 years includes a significant gap in addressing key elements. The elements include the ability to pay for health care, understanding of weight on overall health, and learning the proper ways of determining their weight and calorie intake and output. If adults do not understand the importance of proper weight, food, and exercise then something else has to happen. More drastic strategies are required to change the obesity issue in the United States. There is a significant gap in the data about obesity and the exact manner in which government agencies intend to address the problem. This integrative literature review will address the plan of action for those who cannot meet the expense of going to the primary care provider visit, are unaware of the pertinent data to address their height, weight, calorie intake, and output, and the effects it has on their overall health. This review examined the concepts of interest, research designs, outcome measures, statistical tests, significant findings, relevance of study, and gaps among other items in relation to obesity among adults over 20 years, which gives reference to ten articles.

Search Strategy

In the course of the study, prevalence, obesity, trends, BMI, and risk factors are the key words used in the study. Search engines used to conduct the study included: JAMA, NCHS Data Brief, PubMed, and the National Health Services. The number of articles used for this review is ten and the processes used to narrow down the study’s relevance to overweight and obesity among adults over the age of 20 years.

Integrated Literature Review

Study Purposes

The major part of the study looks into obesity and low health care accessibility by diverse populations around the U.S. The combination of the two variables results in an increase in health risks, which spills down to the added costs in addressing health issues among the adult population. Several challenges as stated by one author are associated with financial, legislative and bureaucratic issues. In some instances, it is evident that the causes of obesity include a significant burden of human discrimination, morbidity, mortality, and social exclusion. This problem is not only an individuals’ problem, but rather, it affects the whole nation of different races and sexes. The article touched on pertinent issues of adult obesity and directs questions to ways of curbing the problem since it has affected a large portion of the adult population. In order to reduce the costs associated with health issues, governments, health institutions and individuals should come together and implement strategies that will foster eradication of poor eating habits, lack of participation in physical activity and improved socioeconomic status.

Sample Characteristics

In the reviewed articles, sample characteristics included race/ethnicity, gender, and age. The location under study is the United States of America and the specific ethnic groups included non-Hispanic black, Mexican American women, non-Hispanic white women (Ogden, Carroll, McDowell, &Flegal, 2007; Healthypeople.gov, 2012). Other ethnic groups include Native Hawaiian, Pacific Islander, American Indian, and Alaska Native (CDC, 2012). One of the studies focused on the socioeconomic status of adults with regard to obesity (National Center for Health Statistics, 2012). For this research, sample characteristics are important because it enables researchers get a glimpse of the population under study and thus, the outcomes can then be applied to a target population. The range is between 20 and 65 years of the sample sizes under study.

Research Designs

The review of literature utilized individual studies and systematic reviews. Four of the studies were a systematic review of random sampling designs (Brown, 2007; McCormick, 2006; American heart association, 2013; Albano, n.d). Measurements of height and weight are also designs used by some of the researchers (Flegal, Carroll, Ogden, & Curtin, 2010; CDC, 2012). Other literature reviews used specific population groups (Healthypeople.gov, 2012); multi-stage design (National Center for Health Statistics, 2012); and healthy people target (Ogden, Carroll, McDowell, & Flegal, 2007).

Theoretical Frameworks

In the review, no theoretical frameworks were provided. However, several clinical environmental influences affected the physical activity and nutritional choices among adults under study. Many health departments in the United Sates have successfully partnered with organizations like the American Association with the aim of implementing health living choices that focus on the prevention of adult obesity and overweight problems across the nation (American heart association, 2013). The program followed the health care model, which supported medical system interventions that concerned obesity. The emphasis of the program was to encourage the adults to engage in physical activity because it reduces their chances of being obese thus; they become knowledgeable on the importance of eating nutritional and healthy foods. In addition, this enables them keep fit, which prolongs their lifespan. Moreover, obesity inequalities were tackled through the implementation of the care model. The theoretical framework showed how interventions are characterized by action levels and their unique approaches to tackling visible inequalities. Public agents and private stakeholders’ collaboration helped interventional components in ensuring that complex epidemic looked into the environmental, educational, and nutritional aspects. In addition, they also looked into socioeconomic status of individuals in order to come up with programs that improve their economic status. This improves their way of living, and eventually, their eating habits also change. In all the articles used, not one of them used a theoretical framework. The importance of having a theoretical framework is to be able to place conducted research of the same discipline within other the perspective of other studies.

Major Components of Interventions

The intervention procedures studied ranged from behavioral management and multi-component behavioral interventions. Questionnaires, health measurement and interviews were the most predominant procedures of intervention aimed at collecting information on the perceptions of health care providers, demographics, and nutrition data assessment of overweight and obesity among older adults (Albano, n.d; American heart association, 2013; Brown T, 2007CDC, 2012; Flegal, Carroll, Ogden, & Curtin, 2010; McCormick, 2006; National Center for Health Statistics, 2012). Healthpeople.gov (2012) used screening tests with the aim of managing behavioral interventions by addressing the barriers associated with change of eating habits among older adults. However, with the increase in health costs, screening is not used by many because their economic status is low to accommodate the budgets of subscribing to a health care institution. Population studies and or surveys were used in determining the mortality and morbidity risks of adults with overweight and obesity issues (Ogden, Yanovski, Carroll, & Flegal, 2007). Quantitative data used variables like weight, height, and body fat percentages.

Outcome Measures

Outcome measures included health risks, physical activity, intervention programs, and demographic information. The study elaborated how lack of physical activity impacts negatively on the rates of obesity due to the increased BMI among adults, which resulted in cardiovascular diseases (Flegal, Carroll, Ogden, & Curtin, 2010; Healthypeople.gov, 2012; Ogden, Carroll, McDowell, & Flegal, 2007). For example, diabetes increases the risk among adults and results in an increase, in adult BMI. Intervention programs used depicted that increased knowledge on nutrition and body mass index reduction had no differences in adult results (Flegal, Carroll, Ogden, & Curtin, 2010; Healthypeople.gov, 2012; Ogden, Carroll, McDowell, & Flegal, 2007).

Major Findings

From the assessment, it is obvious that the prevalence of obesity among adult women is on the rise. Gender roles play an important part in the prevalence ratios (Healthypeople.gov., 2012; Flegal, Carroll, Ogden, & Curtin, 2010; Ogden, Carroll, McDowell, & Flegal, 2007). According to the National Center for Health Statistics, socioeconomic status contributes to the increase of weight among adults since they gain so much weight due to the lack of participating in physical activities (2012). Another aspect is the educational level of participants, which was more to those with no bachelor’s degree among women as compared to men (CDC, 2012). Race or ethnicity is also a causative factor to the increase of obesity among women, as a result, of their cultural beliefs and traditions (Ogden, Carroll, McDowell, & Flegal, 2007). Male adults are not affected by obesity issues, but the few are facing a difficult task of losing weight, which has forced most of them to engage in physical activities and eat healthy diets. The health care providers are guided by these findings in looking for solutions to the rapid increase of obesity among adults.

Other Findings or Unexpected Findings

After careful review of the research, most data concluded that cardiovascular diseases are prevalent and on the rise among the adult population. In other studies, it is also evident that other diseases related to obesity, for example, type 2 diabetes is most prevalent in developing countries (National Center for Health Statistics, 2012). This information has challenged researchers to identify trends in other countries. Most studies encouraged adults to engage in treatment programs that encourage physical behavioral modification and dietary options for obese adults, which are cost effective measures and easier to co-ordinate measures. Children in this case, played a crucial role in supporting, as well as giving support to their parents in management programs and treatment of their condition (obesity). Consequently, examples of theory selection frameworks that include the health belief model encompass social cognitive and self-determination theories, which formed the dominant dialectic theoretical perspective. However, little information is available on how the programs have been able to maintain their loss of weight, and maintain their achieved health status, without falling into the temptation of eating unhealthy foods. Moreover, no specific framework has been identified to guide in the process of decision-making for healthy theory that will apply to the study of obesity and overweight intervention.

Strengths and Weaknesses

The study’s strengths included active participation from participants and other organizations, ethnic/cultural groups range, systematic review and controlled randomized trials percentages, and the level of significance the study attributes to the nurses. The Weaknesses noted include: lack of defined variables, lack of intervention procedures for clinical trials, responses rates were low; range of ethnic groups was deficient, and lack of generalizability. In order to reduce the occurrence of such problems in future, research needs to be conducted further that provide evidence on the importance of study, which helps in providing literature review. When it comes to generalizability, factors contributing to the problem include low rates of response, limited sample size and the lack of different ethnic groups. From the research, bias levels and data reliability have decreased due to the presence of evidence-based research and significance levels of obesity and overweight among adults. In any conducted research, strengths and weaknesses exist to enable researchers to appreciate the work done by others. In addition, it encourages nurses to look for solutions to alleviate obesity and overweight problems globally.

Questions

In any research, gaps are present and in this case, use of questionnaires by several researchers prompted participants to raise the following inquiries. What is the role of parents in the combat of such cases? Intervention programs raised serious concerns and thus, the question concerns how the government plans to reduce obesity cases. In addition, what strategies should be put in place, to ensure that such cases do not affect the health of the nation? Gender issues are still a major concern since many wonder what causes the differences being noticed in the different categories of people registered? In addition, existing relationships are also a cause of obesity especially among women therefore, the relationship between pregnancy and obesity health issues exists, but it is unknown how many older females have continued to gain weight after having children. For many authors, the problem of obesity has been raised several times but, the question that remains unanswered concerns prevention measures of weight that increases interventions at the community or workforce level. Many scientists have been able to invent programs that aim at reducing the escalating numbers of obese adults. However, the question lies with whether behavioral interventions, which aim at reducing screen time, are effective in the different ethnic subgroups, socioeconomic, racial, and gender. The health associations have contributed to data gathering, but how accurate are their results in the current economic times is still an issue. Education aspects is also an issue and prompted others to ask how education levels affect women prevalence rates is a question that needs justification and investigation.

Conclusion

In summary, the major findings of this integrative literature review incorporated data on adult obesity and relationships to physical activity, socioeconomic factors, demographic data, and adverse health outcomes. The increase of BMI among adults is related to their low socioeconomic status, lack of education, increased risks for type 2 diabetes and cardiovascular disease and physical inactivity. Morbidity and mortality levels, discrimination and social exclusion are also factors that cause obesity among adults. Therefore, the research conducted aimed to look for solutions to the causes, but was faced with financial, legislative and bureaucratic aspects. Moreover, decreases in BMI correlates to attainment of undergraduate degrees, social support, and the completion of intervention programs. Upon concluding the literature review, thoughts that arose leaned on the relationship between BMI and socioeconomic factors. It is evident that most females are affected by obesity and overweight problems due to poor eating habits and body changes during and after pregnancy. It is also obvious that the socioeconomic status and education level among females affects their prevalence levels of obesity. Therefore, nurses can be able to investigate between these lines and come up with resolutions to mitigate the problem. Additional research needs to be conducted in order to understand the underlying principle between pregnancy and obese mothers, which will provide recent and reliable information to learners and scientists. Through conceptualizing of evidence range levels and analysis of the ten articles, aspects surrounding adult obesity are identified and thus, further research needs to be conducted. This integrative literature review is relevant and meets the Essentials of Master’s Education programs in Nursing because it emphasizes collaboration between patients and health care providers. Ultimately, this improves health outcomes and strives to curb the obesity menace. For a master’s prepared nurse, it is important to collaborate with multiple disciplines like teachers, counselors, dieticians, and parents in meeting the objective of the study. Disciplines collaborative approach utilized enables an advance practice nurse assist in coordinating adult aspects that improve on health outcomes. Before this review of literature, it was evident that low nutritional levels and physical activity led to the increase of obesity levels among adults. Therefore, this information can be used, by an advanced nurse, to develop and implement strategies to combat the problem and thus, evaluate available strategies for treatment.

References

Albano, K. Case Study: Obesity. Retrieved from

http://www.castonline.ilstu.edu/hurd/KNR378/Articles/Obesity_class.pdf

American heart association, 2013. Overweight & Obesity. Retrieved from

http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319588.pdf

Brown T, 2007. Tackling childhood obesity: A case study in MCH Leadership. Baltimore, MD:

Women’s and children’s health policy center, Johns Hopkins Bloomberg School of

public health.

CDC. (2012). National Center for Chronic Disease Prevention and Health Promotion: Chronic disease indicators: Obesity among adults aged >= 18 years. Retrieved from: http://apps.nccd.cdc.gov/cdi/IndDefinition.aspx?IndicatorDefinitionID=11

Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. JAMA, 303(3): 235-241.

Healthypeople.gov. (2012). Nutrition and Weight Status. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29

McCormick, B, 2006. Economic costs of obesity and the case for government intervention.

London: Department of Health. Retrieved from

http://www.dti.gov.uk/assets/foresight/docs/obesity/161-164.pdf

National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Hyattsville, MD. 2012

Ogden, C. L., Carroll, M. D., McDowell, M. A., & Flegal, K. M. (2007). Obesity among adults in the United States–no statistically significant chance since 2003-2004. NCHS Data Brief (1):1-8.

Ogden, C. L., Yanovski, S. Z., Carroll, M. D., & Flegal, K. M. (2007). The epidemiology of obesity. Gastroenterology 132(6):2087-2102.