Evidence-Based Proposal for Obese and Overweight Adults Assignment

Introduction

Obesity is one of the complex chronic illnesses that occurs due to excessive fat deposits that impair individual health. Consequently, obesity poses a global public health concern, with the United States perceiving it as a national epidemic. By 2022, the global population of adults diagnosed with obesity was over 890 million, which corresponded to 43 percent of individuals aged 18 years and above (World Health Organization, 2024). The number is an increase of 25 percent from 1990 with America’s prevalence being at 67 percent. In the United States, in every three adults, one is usually affected by obesity, with most nations experiencing triple and some double escalation of obesity prevalence within three decades (CDC, 2024). The leading cause of such escalation is linked to a sedentary lifestyle, urbanization, and high consumption of calorie-processed foods. According to the World Health Organization (2024), obese individuals have a body mass index (BMI) of 30 kg/m2 and above, where the higher the BMI range, the higher the mortality risk (World Health Organization, 2024). Adult obesity is also linked to childhood obesity, where, if not well controlled, it may lead to healthcare organizations experiencing a tremendous chronic illness prevention burden to the global healthcare systems. The reason behind such projection is the fact that obesity prevention acts as a critical element in Obesity-related Non-communicable diseases (OR-NCDs) control like hyperlipidemia, Type 2 diabetes, coronary artery disease, hyperinsulinemia and hypertension (CDC, 2024).  Evidence-Based Proposal for Obese and Overweight Adults Assignment

The need to control and prevent obesity has been stressed by the traditional obesity prevention measures failure, particularly in formulating public policies that take a non-stigmatization approach. Such an approach will help will help the health system to shift from the previous focus concerning individual behavior change and approach the issue using environmental change strategies (Ang et al., 2021). Also, individuals diagnosed with obesity tend to face challenges associated with discrimination and bias in places like educational setups, healthcare facilities, and other public settings. Hence, the main reason why such vices should be controlled against obese individuals is to enhance appropriate healthcare resource utilization, early identification of complications, and prevention of morbidity (Alamnia et al., 2021). The proposal focuses on personalized lifestyle modification for obese individuals to initiate behavior changes. The reason for such a proposal is that mobile applications will improve the program delivery and outcome. The individualized mobile-based lifestyle modification intervention will run for six months with an evaluation and monitoring at baseline and after post-implementation. The success of the program will be measured through BMI reduction and an improvement of obesity-related comorbidities to be termed as a practical weight loss approach.

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Problem Statement

Adult obesity is a critical health issue that needs the healthcare system’s attention for it to be resolved. For instance, in the United States, in every five adults, two are diagnosed with obesity, which is illustrated in a study conducted in 2020 showcasing that over 100 million adults in America have the condition and over 22 million have been diagnosed with severe obesity (CDC, 2024). As well, most adults with obesity have other severe chronic conditions like heart disease and diabetes. Another reason why obesity needs to be addressed comprehensively is the fact that the United States spent about $173 billion in 2019 on medical expenditures on obesity, making obesity a costly, common, and chronic severe condition (CDC, 2024). Hence, all stakeholders, ranging from the federal and state governments to the local government and communities, must give the issue much attention to improve overall health outcomes and avoid burdening the government with a variety of medical expenditures emanating from obesity occurrence. Therefore, assessing personalized interventions to reduce obesity rates among adults in the United States will be crucial. Hence, it will be necessary to conduct a literature review to establish the effectiveness of mobile applications in obesity prevention for the target patient population.

PICOT Question

The following PICOT statement will guide the EBP project: “In persons, 18 years and older with obesity (P), does use an individualized, intensive lifestyle modification mobile application program with dietary changes and exercise (I) compared with routine care (C) result in weight loss (O)over six months (T)?” (Appendix 1).

• Population– Adult patients with obesity ages 18-65
• Intervention: Implement an individualized comprehensive weight-management program compared with lifestyle changes.
• Comparison-Weekly weigh check with a visit to see a Dietician
• Outcome-Reduction in body weight and improvement in obesity-related comorbidities (such as hypertension, diabetes, and dyslipidemia)
• Timeframe-6-12 months

Organizational Culture and Readiness

Organizational Culture

The intervention will be conducted in a community hospital that is guided by its mission of enhancing community health by offering safe and high-quality care through the integration of innovations, evidence, and interdisciplinary approaches. The healthcare facility has adopted a hierarchy-based and decentralized leadership and organizational structure with an aim to motivate its subordinates and improve their diversification and growth (Stevens et al., 2022). As Zamboni et al. (2020) posits, healthcare organizations that embrace decentralization tend to experience enhanced communication that leads to innovations and quality care. Such elements contribute to management changes by supporting agility and the ability to respond positively to new standards. Besides, the community hospital’s core values revolve around integrity to promote honesty and healthcare ethics, respect that supports healthcare professionals and management cohesion, collaboration to promote quality services, and inclusion and diversity to be in a position to serve the diverse community. Other values that guide the healthcare organization include prioritizing families and patients and employing professional healthcare staff and providers. All these values present the community hospital as a customer-based facility, which not only improves patient and healthcare staff satisfaction but also enhances the facility’s sustainability and competitiveness (Zamboni et al., 2020). Also, the hospital’s employees rate their healthcare organization as decentralized since they are engaged in active participation in all organizational operations. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Capacity Assessment Framework

The framework applied to evaluate the hospital’s readiness for change is the organizational readiness to change assessment (ORCA). According to Miake-Lye et al. (2020), the tool is characterized by self-reporting, where healthcare organizations measure how well they are prepared for the proposed change. Another advantage that ORCA presents to healthcare organizations is through its three main scales, namely evidence strength concerning the proposed change, organizational context quality that supports the change, and the facility’s capacity to support the change. After the community hospital applied the ORCA tool, the tool projected that their readiness was moderate to high level. Such results show that the healthcare facility harbors a change-enabling environment that recognizes the problem, involves leadership support, and has proposed intervention perception (Miake-Lye et al., 2020). Also, the healthcare staff and leadership understand the importance of obesity management practice change. However, some of the challenges that implementing the individualized mobile-based lifestyle modification intervention may face include knowledge gaps and resource constraints. Hence, before embarking on implementing the proposed intervention, the hospital needs to enhance its organizational capacity by indulging in training the healthcare staff and identifying means to enhance the program’s efficiency.

Health Care Systems and Processes Requiring Cost-Effectiveness, Safety and Quality Improvement

The community hospital’s healthcare staff provide direct care to patients thus the need to incorporate feasible clinical interventions. Therefore, the healthcare system will need to be improved in areas regarding patient handling, cost management, and providing quality-led care (Zamboni et al., 2020). Therefore, it is necessary to impose Quality improvement collaboratives (QICs) by embracing standardized designations and methodologies to collect high-quality data (Zamboni et al., 2020). Also, once the data is collected, there will be a need to conduct data analysis to provide feedback to the healthcare staff, distribute results to the team, and initiate collaboration procedures and techniques to promote coordinated care to the population. Also, Zamboni et al. (2020) posit that QIC integration is crucial in identifying consistent costs to ensure that the healthcare facility integrates a cost-saving system for chronic and acute illnesses.

Organizational Readiness Improvement Strategies

The transtheoretical model (TTM) is the strategy to enhance the community hospital’s readiness for the proposed change. According to De-Freitas et al. (2020), TTM enables healthcare organizations to change by aligning themselves with tailored approaches that meet their organizational needs. The main stage of TTM is the pre-contemplation stage, where the project team has no idea about the changes, followed by the second phase, which revolves around the organization recognizing the change’s benefits even if the risks and costs outweigh the payback. The subsequent phases, that is, the third, which is the preparation phase, and the fourth phase, which represents the action phase, help the organization to induce training for motivation and upskilling purposes. Other factors that the two phases initiate include policy change to fit the solution-focused initiatives for adaptability purposes while encouraging the need to integrate technology within the healthcare system (De-Freitas et al., 2020). As well, the need to integrate big data analytics is an efficient way to enhance organizational readiness through enhancing research-based interventions. Evidence-Based Proposal for Obese and Overweight Adults Assignment

The Project Team Members and Stakeholders

Before the project plan is upheld, the project manager must ensure that they have identified the viable team members and stakeholders. In that case, the project on implementing the personalized mobile application to cater to obesity prevention will involve obese and overweight patients, social workers, primary health professionals, internal and third-party nurse informaticists, community health volunteers, nurse managers, and the community hospital management (Vaz et al., 2021). The obese and overweight patients will be crucial to ensure that the intervention is patient-centered and personalized, while social workers, community health volunteers, and primary health professionals will help in collecting data in real-time to enhance project success. The internal and third-party nurse informaticists will help with technology integration into the current healthcare system and help nurses with workflow interpretation (Alamnia et al., 2021). The nurse manager’s role will be to coordinate with the project team, while the healthcare management will be responsible for resource allocation and reimbursement.

Communication and Information Technologies

The community hospital already operates on electronic health records (EHRs), which will be beneficial to the project team in data collection and retrieving real-time information. However, the team will utilize clinical decision support (CDS) through the help of a nurse informaticists to mitigate errors that may jeopardize the integration of the mobile application since it helps in attaining desired outcomes (Alamnia et al., 2021). Through the involvement of these two technologies, the project team will be motivated to pursue the outcomes to meet the patient’s needs through enhancing reminders, alerts, and notifications adherence.

Literature Review

Obesity Research Overview

Obesity, which is characterized as 30kg/m2, is a common public health issue that is preventable and is associated with a number of chronic disease risks like high blood pressure, diabetes, cancer, and heart disease (World Health Organization, 2024). Due to the high number of adults with obesity globally at 980 million, the healthcare system must identify the effectiveness of enhancing physical activity and reducing weight since they can help minimize the obesity-related comorbidities burden. In that regard, various studies have demonstrated different ways that lifestyle change can maintain and reduce weight (Ang et al., 2021). However, for most people, changing their lifestyle towards weight loss is quite challenging, thus requiring effective interventions that may motivate them to carry out lifestyle changes and set achievable and realistic goals while providing activity rate feedback to help them increase their physical activity and maintain weight loss.

In the search for different interventions to manage obesity, mobile phones have been termed by most researchers as an effective medium in the 21st century since it has made communication easy globally. According to Alamnia et al. (2021), about 75 percent of the global adult population has encountered different mobile-related interventions. Hence, the application of mobile interventions is a promising approach to disease prevention and management since it poses the potential to reach a diverse population. Consequently, researchers have been integrating mobile phone interventions to assess and promote behavior change through offering timely access and interactive sessions to obtain a variety of information and deliver particular context prompts assistance. As Ang et al. (2021) posit, mobile app use has recently contributed to notable success in weight reduction, obesity control, quality of life enhancement, and physical activity increase. Such app-based interventions prove to reduce the previous barriers that traditional approaches possessed and are cost-effective. However, the effectiveness of these mobile apps depends on a number of factors, which include the resources available, the knowledge of the users, and the ways they have been developed to operate. Alamnia et al. (2021), the authors indicate that the mobile application approach tends to be different in a way that it ensures that every participant uses it efficiently and effectively, thus making it an innovative structure that helps in increasing physical activity and managing weight. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Literature Review Synthesis

Most researchers have indulged their research in assessing the effectiveness of behavioral change and disease management interventions through mobile applications. That is expressed by the six studies applied in this literature review, which are all related to the PICOT question, namely, Stevens et al. (2022), Vaz et al. (2021), Beleigoli et al. (2020), Spring et al. (2024, Lugones-Sanchez et al. (2022) and Naz et al. (2023). In that instance, the study by Stevens et al. (2022) supports the need to formulate obesity prevention and management interventions for adults, particularly those ailing from chronic illnesses like severe mental illnesses. The study states that there needs to be more qualitative evidence on the available body weight reduction interventions. However, the study recommendation is that future primary studies must focus on integrative qualitative methodology to assess patients’ experiences on weight management while integrating a standardized guideline to meet transparent and complete reporting. The study also proposes the need to add extra outcome measures that can be used in complementing BMI and weight outcomes like central adiposity and body weight reduction to about five to ten percent or dietary quality change measures.

The other PICOT-related studies focus on the application of mobile apps to facilitate obesity management and prevention in adults. In that regard, the study by Vaz et al. (2021) showed that through using the app-based, interactive, and user-friendly electronically delivered intervention on lifestyle, the prespecified primary outcome concerning weight reduction and the prespecified secondary outcomes on HgbA_1c and waist circumference reduction was achieved. Also, Beleigoli et al. (2020) used 1298 participants, which serves as a significant study strength with an aim to offer diet coaching towards behavior change for the diverse participants from the selected community. The researchers aimed to assess the feasibility of behavior change through personalized web-based human-delivered or computerized feedback and compared the outcomes to the non-personalized interventions for adults diagnosed with obesity or overweight. In both the 12th and 24th weeks, BMI and weight reduced drastically through the platform. Also, Spring et al. (2024) incorporated a wireless feedback system(WFS) to assess its feasibility in controlling obesity. The research findings are that they helped in coaching the participants toward weight loss, but future studies need to ensure that every individual sets specific goals for weight management.

Additionally, for Vaz et al. (2021), such results were similar to the Diabetes Prevention Program (DPP), which led to a weight loss of about 6.79kg within six months. Also, the authors recorded a decrease within the intervention group compared to the control group, thus proving the efficiency of electronically delivered lifestyle towards metabolic health benefits. As well, Beleigoli et al. (2020) stated that for the intervention success, the participant was required to employ substantial time commitment and effort since there was no financial compensation, including the fact they would not retain the devices after study completion. Such factors led to high participant engagement and retention, which led the intervention group had lose 7.16kg on average by six months. Moreover, Beleigoli et al. (2020 findings state that weight loss of less than 2kg in the groups was small and is similar to the recent weight loss programs via the web in comparison to no intervention or face-to-face interventions. Also, the researchers found that consumption of sweetened beverages and ultra-processed foods in the intervention group reduced during the research period compared to the control group, but fruit and vegetable intake increased. Such progress was crucial since, in Brazil, only approximately 34.7 percent of the population consumes five or more servings of fruits and vegetables per day (Beleigoli et al., 2020). Such results are significant also since they show the health benefits linked to fruit and vegetable consumption without any link to weight loss. Hence, this mobile platform group’s superiority when assessed for secondary and primary outcomes when compared to the control groups revealed that different behavioral change approaches that address opportunity, capability, and motivation have a higher chance of enhancing weight loss and dietary behavior change compared to the non-personalized which focus on capability (Spring et al., 2024; Beleigoli et al., 2020).

For Lugones-Sanchez et al. (2022), Spring et al., 2024, and Naz et al. (2023), the studies also focused on weight loss similar to Beleigoli et al., 2020 and Vaz et al. (2021). For instance, Lugones-Sanchez et al. (2022) study, the researchers recruited 650 participants even though only 443 maintained the 12 months visit. From their findings, the authors aimed to assess multi-component mobile health approaches that incorporated brief counseling, a wristband activity tracker, and a smartphone app, which was compared to offering brief counseling only. The main aim of using this intervention was to assess its effect on weight loss, physical activity, body composition enhancement, and caloric intake for Spanish adults with obesity. When assessing the intervention group, some of the benefits that the trial yielded included spending light physical activity, body composition variable, and weight loss at three months compared to the control group. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Consequently, Naz et al. (2023) evaluated the effectiveness of WhatsApp-assisted lifestyle modification towards weight reduction. The study incorporated fifty participants, and the trained nutritionist engaged the participants using motivational interviewing techniques. The main focus of these WhatsApp groups was based on peer support, physical activity, and dietary modification assignments with an aim to achieve a five percent loss of initial body weight for every participant. The study outcomes were that by one year, the participants recorded reduced calorie intake and weight loss. Such factors led the authors to conclude that by offering peer-support assignments, online training, and engaging in a monthly update and follow-up concerning the participant’s weight status through WhatsApp, it was easy to achieve a healthy lifestyle. However, some of the challenges that the participants faced towards a healthy lifestyle include health conditions, separate routines, and household responsibilities. Overall, the online training the researchers identified was an effective initiative since it enabled the participants to gain a positive learning approach due to its accessibility and convenience. However, in Vaz et al. (2021), Naz et al. (2023), and Lugones-Samchez et al. (2022) studies, the researchers emphasize the need to indulge the users in training to increase these mobile applications’ usability and acceptability.

Literature Review Summary

The literature synthesis has assessed the six articles that are related to the PICOT question, which were retrieved from PubMed Central, Google Scholar, and Cochrane, which are all renowned scholarly databases. The first article Stevens et al. (2023) assessed the overall need for obesity-related interventions that can help in managing weight in adults since generalized interventions have been ineffective in managing weight loss in adults with obesity. The other five studies presented different mobile application interventions. These studies have tailored weight loss programs with lifestyle, dietary, and psychological interventions that are effective in the weight loss journey (Beleigoli et al., 2020; Lugones-Samchez et al., 2022; Naz et al., 2023; Spring et al., 2024; Vaz et al., 2021). Consequently, the studies by Lugones-Samchez et al. (2022), Naz et al. (2023), and Vaz et al. (2021) portray mobile use applications as effective during the weight loss journey. However, (Beleigoli et al., 2020) and Spring et al., 2024 the researchers believe that training the staff is necessary before implementing any mobile application to increase usability and acceptability. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Change Model or Framework

The change model that the project will apply is the transtheoretical model of change (TTM), which will guide the project team toward individualized comprehensive intervention on weight loss. The perspective that TTM applies is that the individuals adopting the change must first consider the stage they are in in the change framework during the implementation process (De-Freitas et al., 2020). The change stages will include pre-contemplation that involves individuals who are unaware of the importance of implementing lifestyle or behavioral modification to manage weight (Appendix 2). Such a stage may integrate awareness creation through counseling and education, thus encouraging individuals to embrace lifestyle modification. For the contemplation stage, individuals tend to think about their health, but at that point, they are not yet committed to any particular management intervention. Hence, the main aim of the stage is to address concerns and barriers that may affect the program.

The third step concerns preparation, which involves individuals who begin the weight loss journey but have yet to formulate any action plan. Therefore, healthcare providers must improve the program’s self-efficacy. Within the fourth stage, the individuals engage in action that is accompanied by new behaviors like applying the proposed exercise and dietary changes. Hence, the most critical aspect of the stage is social encouragement and support that will foster social behavior. For the fifth stage, it incorporates maintenance where individuals practice the lifestyle intervention over time. The relevant intervention must involve risk identification and management that may result in relapse (De-Freitas et al., 2020). Overall, the TTM model will enable the target population to reduce weight by enabling the participants to gain tailored interventions.

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Implementation Plan

Setting and Population

The evidence-based project will involve a community hospital setting, and its target population is adults aged 18 to 65. The participants will be recruited from the patient population who will be attending clinics within the healthcare organization. In that case, the inclusion criteria will incorporate individuals who are obese and overweight and whose BMI ranges between 25 to 30 kg/M2 and above. Before the initial implementation plan, the researcher will seek project authorization, and the participants will be issued with an informed consent form. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Timeline

The research is proposed to take place within six to twelve months. The first three weeks will incorporate the intervention preparation, followed by recruitment, which will happen in one week. Afterward, there will be a staff training session within two weeks to bridge the knowledge gap. Then, the project team will engage the patient participants concerning the projects and what they are expected to do mainly in using the mobile application to find the weight management resources. Once the patient participants and the staff have trained, the intervention will be officially launched, and the remaining role will be for the team to monitor the behavior change in participants and weight reduction outcomes within six months after interpretation. Hence, the project evaluation will include an evaluation at baseline, in 6 months, and after one year since its implementation. Once the designated research period is over, the result dissemination will be carried out to promote evidence translation.

Intervention Type

The proposed intervention is an individualized, intensive lifestyle modification that involves exercise and dietary management. The delivery mode for the intervention is via a mobile application where the participants will be receiving dietary coaching for six months. Consequently, the dietary counseling and teaching will incorporate proper meal planning and healthy food options thus the need to ensure collaboration between the participants and the educators to ensure that the meal plan will be easier to adhere to and follow. Besides coaching and teaching, the participants will engage in moderate to vigorous physical activities for six months. Additionally, the participants will receive an appropriate guide towards setting exercise goals with measurement of BMI, dietary habits, and physical activity adherence will be measured before and after interventions.

Project Proposal Resources and Cost

The proposed project will need different resources like mobile application, personnel, data analysis, and staff training, inclusive of other crucial project logistics that will help to sustain the project to its completion. As shown in Appendix 3, the resources budget is $112000. Also, the project team will be sustained using a stipend included in the resources, with the third-party nurse informaticist will be awarded $6000. Other expenditures will include staff training and materials that are estimated at $5000, data analysis will cost $1200, and logistics to sustain the project to its completion is estimated at $3000. Hence, as illustrated in Appendix 3, the total estimated cost for the project is $127,200. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Implementation Barriers and Ways to Overcome Them

Barriers are common during project implementation and may affect the intended outcomes of any project. According to Alamnia et al. (2021), barriers may be internal and external; thus, there is a need to identify them early to apply appropriate mitigation approaches. For the proposed intervention, the main barriers that may affect its success are patients refusing to participate in the project since they may need to be made aware of the benefits the program brings forth. In such a case, the participants may be unwilling to embrace the new intervention. In contrast, others may be discouraged along the way especially if they fail to notice any change or the change is minimal and does not meet their expectations. In such a case, the project team will need to brief the patients on what they expect with the intervention, considering that change intervals may be different for each participant and the overall benefits of participating in the program (Alamnia et al., 2021). Other barriers that may be encountered are the project length and financial constraints that may cause an attrition rate. In such a case, it would be crucial to incorporate appropriate available resources management to help maximize outcomes and reduce cost while ensuring that adequate follow-up is integrated to meet the intended goals of modified behavior adoption.

Evaluation Plan

The expected outcomes for the proposed intervention include exercise and diet lifestyle modification, decreased BMI of approximately 24 kg/M2 and below, and an enhanced outcome for all obesity-related comorbidities. The primary way that the project team will assess the expected outcomes is by evaluating the participant’s self-administered surveys, weight, and clinical checkups by measuring the participant’s BMI, height, and weight from baseline to the project end. For patients with obesity comorbidities, their data will be collected six months after project intervention for follow-up purposes. Consequently, data analysis will be carried out using regression analysis and a chi-square test to assess the intervention’s effectiveness. The ways that the project team will ascertain the intervention’s effectiveness is by enhancing comorbidities outcomes and reducing BMI.

Once the evaluation is done, the following actions will include launching a team to assess reasons why the project failed to yield positive outcomes in case the project does not meet the intended aims. However, the general purpose of the project is to ensure that the proposed intervention will be helpful to adults with weight loss issues and those affected by other obesity-related conditions like cardiovascular conditions or Type 2 diabetes. Hence, the success of the project will be characterized by a positive weight loss journey and an enhancement of obesity comorbidities. Once these evaluations are completed, the project manager and the project team will convene a meeting to assess if the project should be closed, revised, extended, or maintained depending on the evaluation results. Evidence-Based Proposal for Obese and Overweight Adults Assignment

Conclusion

Adult obesity (18–64 years old) is a primary global public health concern, and prevention through lifestyle changes is promoted in the United States. It has been discovered that customized lifestyle adjustments are helpful in starting behavior transformation. Additionally, the mobile application improves program outcomes and delivery. A tailored mobile-based lifestyle modification intervention will be carried out for more than six months as part of the EBP project. The initiative will be assessed and tracked six months after it is put into action and at baseline. A lower body mass index and improvements in comorbidities associated with obesity will show that the intervention is working as a weight loss strategy. Evidence-Based Proposal for Obese and Overweight Adults Assignment