Running head: WEIGHT AND BODY MASS INDEX REDUCTION

Evidence-Based Research on Weight and Body Mass Index (BMI) Reduction Programs
Implemented By Nurses
Lisa Chee
NURS-211
February 28, 2013
Professor Williams

WEIGHT AND BODY MASS INDEX REDUCTION

Obesity is a major healthcare issue in the United States. It is defined as a medical
condition, in which there is an accumulation of excess body fat that causes pressure and stress to
body organs, resulting in the development of adverse disease processes. According to Berman &
Snyder (2012), individuals who are obese, with a body mass index (BMI) greater than 30 kg/m2,
are at risk for chronic health problems, such as hypertension and diabetes mellitus. In 2007, the
United States Department of Health and Human Services (USDHHS) estimated about 300,000
individuals die annually due to chronic diseases associated with overweight and obesity.
Diseases reported include: heart disease, diabetes, stroke, arthritis, cancers and depression
(Turner, Thomas, Wagner & Moseley, 2008).
Statistically, the percentage of adult and childhood obesity is increasing annually across
the United States. Between 2003 to 2004, the percentage of obese adults increased from 23% to
32% (Turner et al., 2008). Additionally, in 2009, the USDHHS estimated about 11% of two to
five year old children, 15.1% of six to eleven year old children and 17.8% of 12-19 year old
teenagers are overweight (Berman & Snyder, 2012). Thus, it is crucial for nurses to implement
effective evidence-based weight and BMI reduction programs to decrease unnecessary weight
gain, in all ages, to avoid long-term health complications associated with obesity.
According to Giddens (2012), the most effective measure to avoid obesity is prevention.
This includes consuming a healthy diet and engaging in a minimum of 150 minutes of physical
activity weekly. However, once an individual has been diagnosed with obesity, intervention is
required, and an effort to lower the individuals weight and BMI is crucial. As a result, nurses
have been trying to provide effective interventions for their patients. Over the years, several
weight management programs, focused on decreasing the BMI of overweight and obese
individuals, have been studied and implemented by nurses and interdisciplinary healthcare

WEIGHT AND BODY MASS INDEX REDUCTION

professionals to improve the quality of life of individuals affected by obesity and obesity related
diseases.
Sabin, Ford, Hunt, Jamal, Crowne and Shield (2007) conducted a qualitative,
observational study in which they monitored the effect of lifestyle and dietary changes on the
Body Mass Index Standard Deviation Scores (BMI SDS) of 137 obese children. Their main goal
in this study was to reduce the participants BMI SDS of -0.5 or greater. Sabin et al. (2007)
conducted their study over a three and a half year period and recruited children, who were
referred to the obesity service center at the Bristol Royal Hospital for Children, and their parents
or guardians for consultation with a pediatrician, dietician and a health and exercise specialist.
According to Sabin et al. (2007), previous studies have shown beneficial results to the child
when the parents are involved; thus, they emphasized family behavior changes to facilitate
weight control. This included the avoidance of snacking on foods high in carbohydrates, the
reduction of consuming drinks high in sugar content (e.g. soda), regulating healthy meals and
negotiating treat days (e.g. chocolates and sweets), as appropriate. In their study, they also
encouraged the children, and their families, to participate in a free, two hour weekly sports
session to enhance physical activity.
Throughout the study, weight was measured using a digital scale and height was
measured using a stadiometer. BMI SDS was then calculated and adjusted for age. As a result,
83% of participants who followed through with the program achieved an overall reduction of
BMI SDS with 28% achieving the target reduction of -0.5. Sabin et al. (2007) concluded that
education, lifestyle/ diet modification and encouragement are key factors in weight reduction.
Turner et al. (2008) utilized a similar approach in which they focused on how diet,
exercise and patient education affects body mass in 109 participants. They utilized a quasi-

WEIGHT AND BODY MASS INDEX REDUCTION

experimental design and collected/evaluated data over a 12 week interdisciplinary Wellness
Program. A total of 12 sessions, which included three exercise sessions and nine group meetings,
were included in the program. The program comprised of two physicians, two psychologists, a
nurse practitioner, an exercise physiologist and a licensed patient educator. In their study, Turner
et al. (2008) educated participants on both healthy and unhealthy behaviors and surveyed
participants regarding their readiness to alter their nutrition and physical activity levels. Three
dietary plans (e.g. low calorie, low fat or low carbohydrate) were offered in this study. The
program provided free access to a local fitness center which included all access to exercise
equipment and a 90 minute aerobics class, to facilitate an increase in physical activities. They
then evaluated the participants adherence to nutritional change and increase in physical activity.
Research data was collected utilizing an intake questionnaire which addressed changes in
activity level and physical or emotional well-being pre and post program completion. At each
meeting, participants were weighed on a Tanita TBF body composition scale and information
regarding their weight, BMI, body fat percentage and basal metabolic rate were recorded. Turner
et al. (2008) concluded that there was no difference in BMI based on diet choice; however, an
increase in physical exercise significantly reduced BMI, with a positive correlation in the
increase number of exercise session and mean weight loss.
Lastly, Sarvestani, Jamalfard, Kargar, Kaveh and Tabatabaee (2009) conducted a study
where they observed how behavior modification could improve eating habits in obese adolescent
females. Similar to studies conducted by Sabin et al. (2007) and Turner et al. (2008), Sarvestani
et al. (2009) also enforced patient education on healthy decision making and increasing physical
activities in their study. Sixty adolescent girls were randomly selected from two schools to
participate in a six months, quasi-experimental designed study. The sixty participants were

WEIGHT AND BODY MASS INDEX REDUCTION

equally divided into experimental and control groups. In the experimental group, participants
engaged in four-hour structured sessions, which included two hours of behavior modification
education and two hours of yoga therapy, over a course of 16 weeks. In the control group,
participants attended only three of the sixteen sessions.
Data regarding each individual BMI and Dutch Eating Behaviour Quesionnaire Score
were recorded. Body weight was measured in light clothing with bare feet and height was
measured in bare feet with a stadiometer. Data was then analyzed using SPSS and two sample ttests were used to examine the differences between the two study groups. Sarvestani et al. (2009)
concluded that there is a statistically significant difference in BMI in the experimental group in
comparison to the control group (-1.07 kg/m2 vs. 0.24 kg/m2, P<0.001); thus, consistently
engaging in healthy lifestyle choices and physical activities significantly contributes to BMI and
weight reduction.
Overall, all three studies provided significant evidence that programs focused on
increasing physical activities, monitoring diets and increasing patient awareness are the key
factors in managing weight gain in obese patients. Specifically, as evidenced by studies
conducted by Turner et al. (2008) and Sarvestani et al. (2009), the greatest impact on weight and
BMI reduction is not so much altering the patients diet, but motivating and encouraging the
individual to engage in physical activities.
Based on the evidence gathered above, as a future nurse, I can educate and stress the
importance of routine physical activities and healthy diet choices to the population affected by
obesity to prevent the progression of severe health diseases and to reduce their overall BMI
scores. With this information, I can also educate the younger population on how to prevent
obesity utilizing the same approach.

WEIGHT AND BODY MASS INDEX REDUCTION

References
Berman A., & Snyder S. (2012). Kozier & Erbs Fundamentals of nursing: Concepts, process,
and practice, (9th ed.). Upper Saddle River, NJ: Pearson Education.
Giddens, J. (2012). Concepts for nursing practice. St. Louis: Elsevier.
Sabin, M., Ford, A., Hunt, L., Jamal, R., Crowne, E., & Shield, J. (2007). Which factors are
associated with a successful outcome in a weight management programme for obese
children. Journal of Evaluation in Clinical Practice, 13 (2), 364-8.
Sarvestani, R., Jamalfard, M., Kargar, M., Kaveh, M., & Tabatabaee, H. (2009). Effect of dietary
behaviour modification on anthropometric indices and eating behaviour in obese
adolescent girls. Journal of Advanced Nursing, 65 (8), 1670-5.
Turner, S., Thomas, A., Wagner, P., & Moseley, G. (2008). A collaborative approach to wellness:
Diet, exercise, and education to impact behavior change. Journal of the American
Academy of Nurse Practitioners, 20 (6), 339-344.