Transtheoretical model of nursing in Obesity Management
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Introduction
Health promotion and nursing theories are strategically proposed to make people and health practitioners aware of managing and controlling different health related conditions. These approach mostly focus on primary and advanced care of a disease. Nursing theories and models are proposed in an expanded form of care that interferes with the whole environment surrounding an individual and involves a range of social and behavioral interventions. There are various nursing theories and models proposed from time to time to manage the health related issues.
In this essay, the Trans Theoretical Model (TTM) based nursing intervention is selected for applying to a specific issue of Obesity that is a big healthcare concern of present times. The TTM is based on the several stages of change that are integrated across the nursing intervention. This theory developed as a result of a comparative evaluation of several theories of behavior change and psychotherapy. The literary research has proven it one of the best approaches for treating the multiple chronic and non-communicable diseases such as Obesity, weight management, primary care in cardiovascular risks and breast cancer (Prochaska, 2013).
TTM focuses on the sequential and behavioral transformation in an individual from an unhealthy and detrimental state to a healthier side. It has been very effective in treating chronic, psychological and behavioral problems such as smoking, psychological disorders, and sedentary lifestyle. The literature is full of numerous studies that show positive outcomes of TTM implementation in treating chronic obesity. The basic construct of TTM is the Stages of Changes (SOC) that exhibit a chronological mode of improvement in the patient’s behavioral or related health patterns. TTM includes a set of five states that are pre-contemplation, contemplation, preparation, action and maintenance. All these steps mutually bring a behavior transformation in a patient. The main driving force behind the behavioral change is the action stage of change in this process. It is a complicated and time-taking process that requires sufficient time to reflect the required changes essential in each stage of the process. Though bringing behavioral changes in an individual is a complex process, literature has witnessed the positive outcomes of TTM implementation for such purposes. In this process, the healthcare practitioner has the most significant role that encourages the individuals to bring those changes to combat the issue (Prochaska, 2013; Johnson et al., 2008).
In such cases, a healthcare practitioner motivates an individual to change his behavior and lifestyle that can be perilous to his health and increases the risks to obesity.
The aim of this essay is to identify a nursing approach for managing a specific issue or concern. In this essay, the selected nursing approach is TTM model based nursing interventions of the current most somber issue of obesity and overweight. The essay will highlight the key points of TTM approach when applying on an obese patient. The essay also covers the epidemiology, pathology, and statistics of obesity.
Issue of Obesity rising as a Global epidemic
Obesity is the biggest health care concern of current time that is rapidly expanding its arms towards our new generation including children, teens and youths. Apart from this group of population adults and older people are also sufferings from this chronic disease. Obesity is growing like an epidemic worldwide and according to a report, it is becoming a substantial health crisis of this century. Obesity has been associated with multiple comorbidities as well as an elevated risk of mortality. The comorbidities linked with Obesity are impacting the healthcare industry at a significant level that is why the nursing profession should care about this issue.
Definition of Obesity
Obesity is a metabolic dysfunction and a low-grade inflammatory condition that denotes the excessive accumulation of fat or adipose tissue in the body. The obese condition is a result of the interaction of various neurotransmitters, insulin receptors, cytokines, and multiple pathways that regulate the intake of food in an individual. There are various ways of measuring the obesity level, but the most popular have been the calculation of BMI (Body Mass Index). BMI presents a relation of body weight and body height in squares. BMI in the range of 25 to 29.9 denotes that the person is overweight while above 30 denotes the starting of obesity. Above 35, it is an advanced stage obesity that requires immediate remediation.
Statistics of obesity
The data statistics on obesity shows a remarkable boost in Obesity prevalence in the last three decades. A World Health Organization (WHO) report of 2008 showed that 1.5 billion adults are overweight, and 500 million are touching the range of obesity. According to Mason et al. (2008), 11% percent of American children are suffering from obesity, while twenty-five percent of American children are touching the scale of being overweight. Seventy-Eight million adults in America are obese while for children and teens this number is 12.5 million. The literature shows that people with low socioeconomic status are highly prone to obesity. A high prevalence of obesity is noticed mostly in minority groups such as African-Americans and Mexican-Americans, where 20-25% population of children are obese. Among black population the BMI range shows a higher trend. The European obesity stats exhibit that 22% of Women and 15% Men are obese. The Caribbean and South America have shown similar trends. Obesity also depicts race related demographics as certain racial groups are prone to obesity, such as Pima Indians, Pacific Islanders, and Hispanics (Alwan, 2011).
Co-morbidities associated with obesity
Obesity imposes multiple adverse effects on health, and it can reduce the life expectancy of an individual. Obesity is linked to forty different medical conditions, and each obese person is suffering from one or more of these conditions. The most prevalent medical conditions are Hypercholesterolemia, High Blood Pressure, Hyperlipidemia, Cardiovascular problems, Diabetes Type I & II, infertility, metabolic disorders, respiratory problems, psychological disturbances and cancers including of colon, breast, ovarian and endometrial carcinoma (Plotnikoff et al., 2001).
The Determinants of Obesity
Etiology of obesity shows that it is a result of an imbalance of energy input and output. There are various positive determinants of obesity that may include metabolic factors, genetic factors, lifestyle dietary patterns, psychological factors and endocrine factors as well as socioeconomic factors (Plotnikoff et al., 2001). Nutrition plays a significant role in obesity which is essential for a healthy body, but excessive ingestion of calories reverses the condition. Current eating trends show that people consume fast foods, and soft drinks at a greater extent that results in the lower intake of nutrients and high intake of calories. The sedentary lifestyle adds fuel to this situation due to long sitting habits in front of television, computers and video games. These habits are rapidly developing among children and adolescents while fast food consumption is also seen high among adults. Appropriate nutrition is necessary for optimal body and brain development and healthy eating and lifestyle habits can thwart the problems linked to obesity and associated morbidities. Several studies investigated the impact of calorie rich diet on the body that revealed a high-calorie diet is full of excessive fats and sugars with fewer fibers that may reduce the proper digestion inducing the obese condition in an individual. Apart from the nutritious food intake, a decline in physical activity is another factor that plays a considerable role in obesity. The fewer activity results in lesser digestion that impact the metabolic and endocrinal balance of the body (Alwan, 2011).
Application of Transtheoretical model of Nursing in obesity management
Johnson and co-researchers (2008), tried to identify the influence of evidence-based interventions using the TTM approach on weight management and controlling obesity. The outcomes of the study showed positive effects on healthy eating habits, and physical activities, managing the emotional distress among patients. The treatment through TTM resulted in a high level of population impact that provided valuable insights to the other behavioral interventions in managing the obesity-linked problems.
Various randomized trials based on internet-based weight management and obesity interventions revealed that the people who are ready to bring changes in their behavior wanted a personalized guidance from counselors. This type of assistance from practitioners and counselors facilitate the fast achievement of the target behaviors and retention of the attained changes during the intervention. Literature suggests that patient-centered and customized population-based interventions have shown high sustainability.
According to the hypothesis behind TTM the human behavior goes through a series of change and when this distinctiveness is integrated into a disease intervention, it produces highly efficient results. In managing obesity through TTM SOC model the patients need to go through a change of dietary behavior as well as physical-activity linked behaviors. The changes will include the food choices such as intake of low fatty food with fiber-rich fruits and vegetables instead of the patients’ choice. Another major change will impact the physical activity pattern as the patient will be asked to workout, exercise and walk instead of using vehicles for small distances. The health practitioners assist the patients in attaining the changes according to the each stage and sustain them for whole life. Following are the SOC of TTM that will describe the whole intervention requirements.
Pre-contemplation Stage
Pre-contemplation Stage is a commencing stage when the patients are not willing to transform and change their unhealthy habits due to hesitation and fear of outcomes. The stage may last up to 6 months when the major objective of the counselor is to convince the patient and make him aware of the results of the intervention (Glanz, Rimer & Viswanath, 2008).
Contemplation stage
Pre-contemplation Stage is followed by contemplation Stage that signifies the convinced stage of the patient. At this stage, the patient is ready to change his unhealthy habits over the period of next six months. This stage involves knowledge transfer and evaluation of the patients’ chaos regarding the outcomes (Glanz, Rimer & Viswanath, 2008).
Preparation Stage
Preparation stage depicts a determined stage of the patient to transform that may last up to 30 days. By this stage the patient has been mentally prepared, so the minute steps are left such as designing the plan of action, setting health classes and consultation schedules with practitioner and physicians. The patient should be motivated to get involved in the planning and his confidence in self-transformation should be enhanced.
Action stage
Action stage is the major stage when the attained behavioral changes are visible that shows the dedication of the patients towards achieving the health-related goals such as reducing weight. Appreciation, support and motivation are the key factors that help an obese person to bring, and sustain the required changes.
Maintenance stage
This last stage is the advanced stage where the person has transformed and adapted many apparent changes that are helpful for reducing the weight, risks of obesity and associated risks. It is a sensitive stage that has a probability of reverts. The TTM model has been very effective in managing the obesity and literature has shown that a sustainable condition post-treatment may last up to 5 years.
The primary recommendations for health practitioners and nurses when dealing with obesity through TTM include a motivational and encouraging spirit towards the patient. Prevention and early prognosis of the problem with appropriate treatment is an essential part of TTM approach. Several efforts can be made at federal levels to reduce the susceptibility and incidence of obesity as an epidemic. Promoting physical activities and appreciating the efforts made by patients as well as encouraging the employment of provided tools would also be helpful. For example, the government can build parks, bicycle paths, and pedestrian to encourage the population to increase the physical activities and exercises. At social and family level several small precautions taken can deliver the bigger results among children and teens and put off the sedentary lifestyle (Logue et al., 2005).
Conclusion
The essay presented the obesity as a specific issue and concern of healthcare profession and TTM Nursing based intervention model is proposed as one of the best solutions for managing the problem. Customized and stage-matched, behavior interventions using TTM approach has shown significant impacts on the progression to transformation towards healthy habits and exercise schedules. It has also shown sustainable outcomes that lasted for 5-6 years. The literature has exhibited that TTM has the distinct potential to manage the problems that require behavioral transformation such as eating habits and idleness in Obesity.
References
Alwan, A. (2011). Global status report on noncommunicable diseases 2010. World Health
Organization.
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education:
theory, research, and practice. John Wiley & Sons.
Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., &
Sherman, K. (2008). Transtheoretical model-based multiple behavior intervention for
weight management: effectiveness on a population basis. Preventive medicine, 46(3),
238-246.
Logue, E., Sutton, K., Jarjoura, D., Smucker, W., Baughman, K., & Capers, C. (2005).
Transtheoretical Model‐Chronic Disease Care for Obesity in Primary Care: A
Randomized Trial. Obesity research, 13(5), 917-927.
Mason, H. N., Crabtree, V., Caudill, P., & Topp, R. (2008). Childhood obesity: a transtheoretical
Plotnikoff, R. C., Hotz, S. B., Birkett, N. J., & Courneya, K. S. (2001). Exercise and the
transtheoretical model: a longitudinal test of a population sample. Preventive
medicine, 33(5), 441-452.
Prochaska, J. O. (2013). Transtheoretical model of behavior change. InEncyclopedia of
behavioral medicine (pp. 1997-2000). Springer New York.
