Critical Appraisail of Literature Review: Obesity

CRITICAL APPRAISAL OF LITERATURE REVIEWByInstitution
Abstract
Obesity has emerged as a threat to many people, due to its association with lifestyle diseases such as diabetes and cancer. Many health programmes that aim to help people shed off extra weight exist, but lack of enough data to substantiate the effectiveness of these methods remains the major bottleneck (Murphy & Barr, 2005). This is an appraisal of a study done by Truby, Baic, Fox, Livingstone, Logan, Macdonald, and Millward, to identify the viability of four commercial dietary programmes. These programmes include the Dr. Atkins diet revolution, Rosemary Conley, Weight Watchers, and Slim-Fast dietary programmes. The study utilizes a double-blinded randomized trial where 300 participants take part in the exercise. This method of randomization helps avoiding bias caused by preconceived ideas or knowledge (Sibbald, & Roland, 1998). Each group consist of 60 participants taking the exercise through five stations. The participants undergo assessment at beginning of the exercise, at two months, at six months and at 12months to track the changes in weight, body fat, cholesterol level and blood pressure (Truby et al. 2006). The analysis of the data from these participants provides information regarding participants’ behaviour and the viability of each programme. The study showed that participants who adhered to the respective dietary patters managed to shed at least 10% of their body weight. Participants also tended to favour dietary programmes that involved group participations.
Critical Appraisal of Literature Review
Introduction
The research study; Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials”, done by Truby and others in 2006, aims to compare the effectiveness of four different commercial weight losses diet programs. According to Truby et al. (2006), the pervasiveness of obesity and the dangers associated with it is increasing daily in the United Kingdom, with almost half of the population being overweight and getting in danger of being obese. The National Health Services incurs a cost of $0.9 billion annually, with the general economy affected by an annual additional expenditure of £2 billion (Vlad, 2003). Despite the introduction of effective commercial weight loss diets, the diet plans remain poor due to lack of dedication to weight loss (Butland et al. 2007).
The weight loss industry is very profitable. It has attracted players who developed weight loss programmes such as Slim-Fast Plan, Weight Watchers, Dr. Atkins new diet revolution, and Rosemary Conley’s diet (Truby et al., 2006). In the paper, the authors argue that there is no substantial data from these weight loss programmes to aid in making a clinical judgement on the recommended approach towards healthy living. According to Bowling (2014), medical and health services research is essential in knowing the health needs of the population in order to gather data that aid in choosing the appropriate efficient, cost-effective and reliable health services for people at all levels. It also aids in the assessment of the quality of services offered and auditing of the health practises to improve patient outcome. It is essential in the nursing and medical practise to maintain integrity as a way of adding value to patient care (Edwards, 2009).
Truby at al. (2006) aims to compare the efficiency of the four commercial weight loss programmes available to UK residents, with an assumption that they will yield different results. The study was done in comparison to a control group, while tracking changes in weight and body fat over a period of six months, and finally evaluating weigh changes and dieting behaviours of the participants at 12 months. The study uses the Critical Appraisal Skills Program (CASP) tool of 2010 to perform this quantitative analysis. CASP tools enable the assessment of qualitative and quantitative researches by providing the guidelines on analysis of the research study. The tool consists of questions and requirements ordered chronologically according to the design of research papers, analysis of each section done using several questions (Katrak, 2004). CASP provides a simple way of making a research report easier for anyone to read. However, it requires reflexivity and concentration in making research methodologies more explicit (Newton et al., 2011).
Methods
The “controlled parallel dietary intervention study” utilized an unblended randomized trial in which a control group accessed the treatment. Bland (2015) posits that randomized trials aid in weeding out errors and increase the viability of the study since the changes that occurs are taken as the result of the treatment process. The researchers conducted this study at Nottingham University, Queen Margaret University College, Bristol University, Ulster University, and Surrey University in the UK. The study used participants withdrawn within 30 miles of the study area using British Broadcasting Services and other media (Truby et al., 2006). The participants had a body mass index of 27- 40 and were aged between 18 and 65 years old. The participants selected were 300, and the basis of their selection depended on their health status: only healthy individuals were eligible, to avoid bias caused by treatments or lifestyle.
In the study, the researchers determined that each of the five treatments groups required 60 participants, with an expected dropout rate of 25%, that would provide approximately 80% chance of getting a true difference of a of 4kg loss in body weight and 3kg body fat (Truby et al., 2006). This provided a 5% significance level. Each study centre aimed to use 60 participants, in which during the study seven participants left. The participants underwent stratification according to gender before randomly assigned to groups. During the study, there were several interventions for each group to allow replication. The participants in the Weight Watchers and Rose Conley group received support to join their respective classes, with the parent companies assuring commitment of providing standard care. The participants in the Slim-Fast programme received a reimbursement of up to two meals and a support pack, while those in the Dr. Atkins group received a copy of the New Diet Revolution (Truby et al., 2006).
During the study, the researchers took height, weight, waist circumference, fasting blood, blood pressure and body fat b y whole body dual x ray absorptiometry measurements at the baseline, two months and size months (Truby et al., 2006). Measurements done at monthly level included waist circumference, blood pressure, and weight. The secondary measures taken in the study included “monitoring the renal function in the Atkins group by urea, electrolytes, and cystatin C” (Truby et al. 2006). The only changes realized after the beginning of the trial included offering participants in the Dr.Atkins group with multivitamins supplements at week 10 as they were to use them according to the book. Participants who exited the trial prematurely filled an exit questionnaire. Although randomization was employed in the study, the researchers were unable to blind the participants from the diets, while no attempt was made to blind the investigators during data analysis or during study.
In the study, the primary analyses was for treating basis, with missing values replaced with baseline values carried forward. The secondary analyses targeted participants who provided complete data. The study used analysis of variance (ANOVA), to prove that for participants who completed the test, the tests centre did not affect their total weight loss. The analysis of change in weight was possible using the baseline weight as a covariate since it was relative to the total weight loss (Truby et al., 2006). The researchers used ANOVA to show difference between groups. Additionally, other statistical methods were useful in performing other subgroup analyses. Levene’s statistics was for assessing homogeneity of variance and testing of normal distribution (Truby et al., 2006). The researchers conducted the T test for subjects who withdrew and those that completed for continuous ...