Ethical issues in weight loss intervention - Literature review Example

Ethical issues in weight loss intervention Adults present special challenges in adjusting to the weight loss interventions. This is because, while the weight loss problems in most children who are obese and overweight could be as a result of dietary problems and genetic makeup, the case is very different for the adults. Adults are faced by external factors such as stress, depression, economic challenges and social isolation, all of which are external factors that can affect the effectiveness of the weight loss intervention method that is applied (Fei, et al., 2014). Regular activity is a major physiological intervention that is effective in addressing most of the chronic health conditions that are associated with overweight and obesity. However, the effectiveness of this intervention is largely dependent both on the level of motivation of the adult individual suffering from overweight, as well as the mental state of the individual (Benyamini, et al., 2013). Studies have indicated that most women are sedentary, thus they demonstrate low level of leisure-time physical activity at only 19.8%, resulting in the high rate of such women suffering disproportionately from obesity and overweight, compared to men (Kitson, et al., 2013). However, there are a range of ethical contributory factors that might be affecting the ability of such women to participate effectively in the physical activities and other weight loss intervention programs. Obesity Stigma Obesity stigma is a major factor that deteriorates the psychological and the physical health of the individuals suffering from the overweight and obesity problems (Puhl & Heuer, 2010). Nevertheless, the public health implication of this ethical issue has often been ignored, with the healthcare professionals commenting negatively on the weight and the body shape of the individual suffering from the overweight problem, as a way of motivating them to participate in the relevant weight loss interventions (Monteath &, McCabe, 1997). The implication of such negative comments is that they increase the level of obesity and overweight stigmatization already suffered by the individual, which arises from similar comments from family, friends and the society. Thus, instead of such negative comments helping the individuals affected by the overweight problem to adapt healthy behaviors, the comments serves to demoralize them, lower their self-esteem and self-confidence in the weight loss intervention programs, and consequently discourage them from effective participation (Fei, et al., 2014). The stigmatization of the obese individuals threatens public health, considering that it creates reluctance in the individuals’ willingness to seek the intervention measures that can address their overweight problems, rather opting to live with their conditions Obesity stereotyping Obesity stereotyping is yet another major ethical issue that the weight loss intervention programs must address adequately. There are numerous weight-based stereotypes circulating within the society, which holds that for example, obese and overweight people are lazy, greedy, unintelligent and weak-willed (Puhl & Heuer, 2010). Further stereotyping of the overweight and the obese individuals have observed that such people are unsuccessful, non-committal to good health, unsuccessful, lack self discipline and are non-compliant to the weight loss interventions (Puhl & Heuer, 2010). It is such obesity and overweight stereotyping that has seen such individuals being discriminated in different societal platforms, starting with family and spousal interpersonal relationships, to the workplace discrimination, social events prejudice and health facilities discrimination. The effect of such discrimination to the individuals is that they are affected both psychologically and emotionally, thus discouraged from participating in the relevant weight loss intervention programs (Newman, 2009). The obese stereotyping has become a form of socially accepted bias within the society. In this respect, it is not uncommon to have individuals, who are obese or overweight being criticized by their coworkers, love partners, teachers, family, employers, physicians and friends (Kitson, et al., 2013). Recent statistics have indicated that the prevalence of weight discrimination has increased by 66% within the past one decade, and thus the prevalence and effect of obesity and overweight discrimination is now being ranked the same as racial discrimination in America (Puhl & Heuer, 2010). Conclusion of evidence Ultimately, the research literature reviewed is highly inconclusive on whether or not the prevailing interventions of weight-loss could potentially yield significant weight-loss maintenance in the longer term, despite prevalence of evidence drawn from clinical trials of the perceived effectiveness of interventions in the short term (Tek, Ratliff & Chwastiak, 2011). However, the combination of low-energy diet and exercises has emerged as the best weight loss intervention (Latner, Stunkard, Wilson & Jackson, 2006). Evidence has indicated that the application of low-energy diets alongside family-based exercising has been an effective clinical strategy for addressing obesity (Pekkarinen & Mustajoki, 1997). Research has suggested that the treatment of obesity through alternative interventions that do not entail behavior modification and dietary change cannot yield positive outcome in the long-term (Soderlund, Fischer & Johansson, 2009). Therefore, it is recommended that Very-low-energy diets (VLED) alongside behavior therapy, as a weight loss intervention program would enable a patient to sustain weight loss through the long-term. A recent study has indicated that in addressing the obesity problem especially for women, the application of Home-Based Individually Tailored Physical Activity (HIPP) is very effective (Pekmezi, 2013). This program was especially designed to address the ethical issue of lack of adequate time and space for women to attend to physical activity-based weight loss intervention programs, due to the issues of safety and security risks, as well as domestic responsibilities (Pekmezi, 2013). Therefore, when such home-based physical exercising activities are combined with the consumption of low-energy diets, women are able to actively and continuously participate in the weight loss intervention programs in the long-term. In addition, there is sufficient evidence to the effect that family based behavioral treatment of obesity in clinical settings is effective, through various researches and case studies that have been conducted in Britain (Edwards et al., 2006). Further compelling evidence has shown that the combination of low-energy diets with behavioral, lifestyle and physical activities within the home setting produces very positive results in relation to weight loss for individuals with obesity in the long-term (Melville et al., 2011). The evidence has added that the application of family-base interventions reinforces both the behavioral and the dietary change without causing any adverse psychological consequences for individuals suffering from obesity (Walls et al., 2012). While recommending the Low-energy diets alongside family-based therapy as the comprehensive and suitable weight loss intervention, various ethical issues have been put into consideration. A family-based intervention enables the individual suffering from obesity to overcome the challenges associated with demoralization, since the family is able to support and encourage the individual through the intervention program (Puhl & Heuer, 2010). In addition, the economic considerations such as poverty and other social-economic factors are catered for through recommending low-energy diets alongside family-based therapy weight loss intervention, since the home-based family therapy is not as costly as the pharmacological treatment (Latner, Stunkard, Wilson & Jackson, 2006). The other major advantage that is associated with the recommendation for low-energy diets alongside family-based therapy is the fact that; evidence has shown that there is a low level of clinician involvement in the treatment of obesity, since it has been regarded as a chronic disease (Rippe, Crossley, & Ringer, 1998). Therefore, the recommended weight loss intervention that is based on the family therapy will help the patient in overcoming the limitation of lack of adequate obesity treatment from clinicians. Recommended intervention to "Elizabeth" to manage her weight in the long-term The recommended intervention that is effective in achieving weight loss for Elizabeth must be capable of addressing the multi-factorial causes of obesity (Marín-Guerrero, Gutiérrez-Fisac, Guallar-Castillón, Banegas & Rodríguez-Artalejo, 2008). Therefore, it has to comprise of weight loss interventions that will be comprehensive in ensuring that both the dietary patterns and the physical exercising, which are primarily effective in addressing the obesity and weight loss are addressed (Hainer, 2011). Additionally, the recommended intervention should also be able to ensure the sustainability of the weight loss in the long-term (Cooper et al., 2010). Therefore, in consideration of the above fundamental requirements of an effective weight loss intervention program, Combined Low-energy diet and home/family-based exercising has been recommended as the weight loss intervention program appropriate for Elizabeth. Combined Low-energy diet and home/family-based exercising Evidence has shown that obesity is a multi-factorial disorder that is caused by a variety of factors such as genetic, metabolic, environmental, social economic and behavioral factors (Marín-Guerrero, Gutiérrez-Fisac, Guallar-Castillón, Banegas & Rodríguez-Artalejo, 2008). Therefore, recommending an appropriate intervention program for Elizabeth requires that such a weight loss intervention program can cater for multivariate factors. In this respect, the comprehensive weight loss intervention program that is recommended for Elizabeth to manage her weight in the long-term is adoption of combined Low-energy diet and Home/Family-based exercising. Evidence has shown that the increasing rates of obesity in the Australian population, which is the same with all the other societies globally, is as a result of increasing levels of physical inactivity as well as the shifts in food consumption patterns (Banwell, Hinde, Dixon & Sibthorpe, 2005). This being the case, it is evident that to reduce the rates of obesity that is so rampant in the society, weight loss interventions that target to address the increased levels of physical inactivity as well as address the shifts in food consumption pattern should be recommended for patients suffering from obesity. Further, studies have indicated that women represents the social group that is highly prone to suffering obesity due to being sedentary and increasingly failing to engage in physical activities, with women indicating a low level of leisure-time physical activity at only 19.8%, which makes them disproportionately prone to obesity compared to men (Kitson, et al., 2013). Considering that Elizabeth is a woman, there is no doubt then, that she falls under the category of the most vulnerable group to obesity, as a result of lack of physical exercises. How Combined Low-energy diet and home/family-based exercising recommended for Elizabeth will address dietary patterns In relation to the issue of dietary patterns as a cause of increasing rate of obesity in the society, studies have shown that the new dietary habits adapted by the modern society, coupled with a sedentary lifestyle, are increasingly leading to high rate of chronic diseases and also increased rate of premature mortality (Cooper et al., 2010). This being the case, an effective weight loss intervention program that is recommended for patients must be considerate of the dietary implications to their weight. The obesity stigmatization and stereotyping are based on the notion that the obese and overweight individuals have poor dietary hygiene, causing them to be stereotyped as lazy, greedy, unintelligent and weak-willed (Puhl & Heuer, 2010). While the stereotypes could be based on other factors, it is the dietary factor that the societal stereotype has always associated with obesity, because it is largely believed that large body sizes and high weights are functions of the eating behaviors of individuals. Therefore, to ensure that the dietary concerns are addressed, the weight loss intervention recommended for Elizabeth must entail the dietary pattern change, from consuming high energy, to consuming low energy diets, which is a sustainable intervention for enabling her lose weight in the long-term (Pekmezi, 2013). Therefore the recommendation of a weight loss intervention program comprising of combined Low-energy diet and home/family-based exercising for Elizabeth is based on these evidences, which then shows that if she adapts this nature of weight loss intervention, she is likely to sustain the weight loss throughout the long-term. How Combined Low-energy diet and home/family-based exercising recommended for Elizabeth will address ethical and practical concerns The recommendation for combined low-energy diet and home/family-based exercising as the weight loss intervention program for Elizabeth has been informed by further ethical and practical evidences drawn from different scientific studies. It has been proven that anti-obesity drugs work as alternatives to patients who have failed to register significant positive results in weight loss interventions that entail lifestyle change programs, diet and physical exercising (Hainer, 2011). This simply serves to indicate that the primary and the most fundamental intervention that is recommendable for weight loss is the intervention that will entail addressing the dietary and the physical exercising limitations for the obesity patients. Besides, studies have recommended that the application of alternative weight loss interventions such as the pharmacological treatments should be applied where the behaviorally and lifestyle change-based interventions have first been applied, since this is when the pharmacological treatments can yield positive results (Mersebach, Klose, Svendsen, Astrup & Feldt-Rasmussen, 2004). This simply means that the weight loss intervention programs based on addressing the dietary and the physical activity limitations cannot be simply wished away, since they form the fundamental baseline of achieving positive weight loss intervention outcomes. The long term clinical trials of weight-loss efficacy for patients suffering from obesity has presented dietary change and physical activity as the most effective interventions for addressing obesity and overweight, most especially because they are not associated with any side effects, as happens with pharmacological treatment interventions (Tek, Ratliff & Chwastiak,2011). How Combined Low-energy diet and home/family-based exercising recommended for Elizabeth will address Weight loss sustainability The concept of weight loss sustainability in the long-term is also very crucial while recommending a weight loss intervention program for patients suffering from obesity. Evidence have shown that the efficacy of weight loss intervention is determined by the ability of an obesity weight loss intervention to yield long-term maintenance of weight loss, while at the same time preventing post-treatment weight gain (Cooper et al., 2010). Further, Cooper et al., 2010 maintains that it is not easy for individuals to sustain weight loss in the long term, where constant behavioral and lifestyle changes are not adapted. Karlsen (2013) adds that pharmacological treatment is applied seasonally, and thus poses the risk of weight gain in the post-treatment phase. However, these shortcomings have been accurately offset by the recommendation for combined low-energy diet and home/family-based exercising as the weight loss intervention program for Elizabeth. This is because, through both dietary change and physical exercising, she will be able to sustain the weight loss progress in the long-term. This is the point that Latner, Stunkard, Wilson & Jackson (2006) sought to emphasize, while arguing that the limitation of pharmacological treatment as a recommended weight loss program for patients is that; it is not available for a vast majority of patients. This simply means that recommending a pharmacological treatment intervention for Elizabeth would be creating for her a program that is not sustainable (Puhl & Heuer, 2010). Therefore, by recommending combined low-energy diet and home/family-based exercising weight loss intervention for Elizabeth, the core of weight loss management, which is long-term sustainability, has been adequately addressed. References Banwell, C., Hinde, S., Dixon, J., & Sibthorpe, B. (2005). Reflections on expert consensus: A case study of the social trends contributing to obesity. European Journal of Public Health, 15(6), 564-8. Benyamini, Y., et al. (2013). A Structured Intentions and Action-Planning Intervention Improves. American Journal of Health Promotion 28(2), 119-127. Cooper, Z., Doll, H. A., Hawker, D. M., Byrne, S., et al. (2010). Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behaviour Research and Therapy, 48(8), 706. Edwards, C., Nicholls, D., Croker, H., S, V. Z., Viner, R., et al. (2006). Family-based behavioural treatment of obesity: Acceptability and effectiveness in the UK. European Journal of Clinical Nutrition, 60(5), 587-92.  Fei, X., et al. (2014). A school-based comprehensive lifestyle intervention among Chinese kids against Obesity in Nanjing City, China: the baseline data. Asia Pacific Journal Of Clinical Nutrition, 23(1), 48-54. Karlsen, T. (2013). Predictors of weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study. Health & Quality Of Life Outcomes, 11(1), 1-9. Kitson, A. L., et al. (2013). The prevention and reduction of weight loss in an acute tertiary care setting: protocol for a pragmatic stepped wedge randomised cluster trial (the PRoWL project). BMC Health Services Research, 13(1), 1-9. Latner, J. D., Stunkard, A. J., Wilson, G. T., & Jackson, M. L. (2006). The perceived effectiveness of continuing care and group support in the long-term self-help treatment of obesity. Obesity, 14(3), 464-71.  Marín-Guerrero, C., Gutiérrez-Fisac L., Guallar-Castillón P., Banegas R. & Rodríguez-Artalejo F. (2008). Eating behaviours and obesity in the adult population of Spain. The British Journal of Nutrition, 100(5), 1142-8.  Mersebach, H., Klose, M., Svendsen, O. L., Astrup, A. & Feldt-Rasmussen, U. (2004). Combined dietary and pharmacological weight management in obese hypopituitary patients. Obesity Research, 12(11), 1835-1843.  Rippe, J. M., Crossley, S., & Ringer, R. (1998). Obesity as a chronic disease: Modern medical and lifestyle management.American Dietetic Association.Journal of the American Dietetic Association, S9-15. Tek, C., Ratliff, J. C., &Chwastiak, L. (2011). Pharmacological treatment of obesity. Psychiatric Annals, 41(10), 489-495.  Read More