American Heart Association Lifestyle Recommendations to Redu.docx

American Heart Association Lifestyle Recommendations to
Reduce Obesity
Yuritza Medina
Chamberlain College of Nursing
NR709 Project and Practicum IV
Summer 2022
Abstract Past tense
The prevalence of obesity and sedentary lifestyle complications
are increasing at alarming rates, representing a common but
preventable cause of severe medical complications like
diabetes, cardiovascular diseases, and early mortality. This
common but chronic condition has been for a long time a public
health concern and social determinant. The integrative review
focused on how the American Heart Association (AHA) Diet
and Lifestyle recommendations and the Fitbit app are used as
innovative solutions to reduce obesity in adult patients. The
Fitbit app offers a unique opportunity to enhance the efficacy of

weight loss plans, as it is used to track activity, monitor steps,
heart rate, energy expenditure, sleep, and sedentary behavior.
Research Methodology: A systematic review was conducted to
identify research articles completed in the preceding 4-5 years
centered on obesity care, diet, physical activity, activity
trackers, and lifestyle implications. The databases searched
were Chamberlain Library, PubMed, and CINHAL.
Results and Discussion: Initial searches yielded over 2000
articles, of which 45 were chosen and examined because they fit
the integrative review's theme. The 15 papers most relevant to
the PICOT question were studied in further detail and appraised
using the Johns Hopkins Evidence Appraisal table. The studies
reported positive physical activity outcomes. What were the key
themes?
Conclusions and Further Recommendations:This systematic
review supported the effectiveness of the AHA Diet and
Lifestyle recommendations to prevent and reduce obesity, and
clinical use is recommended. Fitbit app provides new ways to
improve physical activity habits, and the easy availability of
electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle
recommendations; Obesity management; Physical activity
intervention using Fitbit activity trackers.
Dedication
In dedication to my family for their steadfast support of this
project; their cooperation means a lot to me. To my husband
Armando, thank you for your love, understanding, and patience
during this time. I credit my achievement to all of you for your
unwavering love and belief in me.
Acknowledgments

First, I must acknowledge the help of all my professors from
Chamberlain University, who inspired, encouraged, and
supported me throughout the DNP program. My heartfelt thanks
to my teammates, without whom I would never have completed
this phase in my life. Their encouragement has had a significant
influence on my strong determination during this trip.
Contents
Reduce Obesity 1
Abstract 2
Dedication 3
Acknowledgments 4
Introduction 6
Problem Statement 7
Significance of the Practice Problem 7
Theory or Translational Science Framework 8
Methodology 10
Review Protocol 10
Inclusion/Exclusion Criteria 11
Results and Discussion 13
Characterization of the Body of Literature 13
Findings Synthesis 15
Conclusions and Further Recommendations 20
Implications for Nursing Practice 20
Conclusions and Contributions to the Professions of Nursing 21
Recommendations 22
References 23
Appendix A 28
1
5
Reduce Obesity

The entire paper needs to be in past tense – this is a
retrospective review of the literature on your evidence based
intervention
Obesity is a global epidemic that impacts an estimated 650
million individuals worldwide, causing 2.8 million deaths
annually (WHO, 2021; CDC, 2021). Despite efforts to prevent
and manage obesity, the numbers are still increasing, and in the
USA alone, more than 300,000 deaths are recorded yearly
(CDC, 2021). Also is devastating the emotional, social,
financial, and other implications that this serious health concern
has at a patient, community, national, and international level.
The AHA recommends lifestyle interventions that can reduce
the prevalence of obesity and make people live within the
clinically appropriate weight (Bray & Ryan, 2020). The
recommendations are found in literature and practice, but few
researchers have analyzed the literature on the effectiveness of
these interventions.
Wearables and smartphone applications provide new ways to
improve physical activity habits (Gal et al., 2018), and
researchers have further acknowledged technology's role in
enhancing these interventions' outcomes. This integrative
review presented quality and credible sources that established
evidence of the efficacy of the AHA Diet and Lifestyle
recommendations to reduce and prevent obesity in adult
patients. Also, the role of wearable trackers and mobile
applications and what can be done to enhance the effectiveness
of these interventions were analyzed. The review started by
defining the problem, its significance, and the translation
framework that served as its foundation. The DNP student
discussed the methodology, capturing the review protocol, how
studies were included or excluded, and how data was analyzed.
Further, the DNP student characterized the body of literature
used in the review and later synthesized findings that informed
the recommendation of the AHA lifestyle interventions to
reduce weight.Problem Statement past tense

Obesity represents a common but preventable cause of
morbidity and severe medical complications (WHO, 2021).
Despite efforts to curb the issue, globally, the annual cases of
obesity continue to rise, affecting people's health (CDC, 2021;
Carbone et al., 2022). According to the literature, for patients
with obesity or a sedentary lifestyle, physical activity and a
healthy lifestyle are advised to minimize the risk of chronic
diseases such as diabetes, cardiovascular disease, and cancer
(Lavie et al., 2019). The easy availability of sophisticated
activity trackers such as Fitbit offers a unique opportunity to
use it to improve physical activity habits (Gal et al., 2018).
These advanced activity trackers can monitor steps, heart rate,
energy expenditure, sleep, sedentary behavior, and physical
activity intensity (Vandelanotte et al., 2018). The inquiry
question which provided direction for the integrative review
was: In overweight adult patients in a primary care clinic, what
is the impact of implementing the American Heart Association
Diet and Lifestyle recommendations, compared to standard care,
on body weight in 8-10 weeks?Significance of the Practice
Problem past tense
Obesity has become a global epidemic, with at least 2.8 million
people dying yearly from being overweight or obese (WHO,
2021). Obesity has several negative consequences for
population health and healthcare costs (Carbone et al., 2022).
Sedentary behavior and physical inactivity are two of the most
common modifiable risk factors in obese patients. Obesity is a
chronic condition linked to higher mortality and morbidity rates
(WHO, 2021). According to the Centers for Disease Control and
Prevention, it causes an estimated 300,000 fatalities yearly in
the United States (CDC, 2021). Obesity co-morbidities include
heart disease, stroke, type 2 diabetes, and some kinds of cancer,
contributing to a lower quality of life and shorter life
expectancy. Obesity affects 93.3 million persons in the United
States and is one of the primary causes of avoidable and early

mortality (CDC, 2021).
At the national level, the rate of obesity-related diseases
represents a severe public health concern that negatively
impacts the community's quality of life and nursing care
expenses. According to the CDC 2021, obesity is a common,
powerful, and costly disease, and the prevalence and incidence
remain high in the United States. The Centers for Disease
Control and Prevention (CDC) reports that 42.4% of all adults
in the United States are fat, and 650 million individuals
worldwide are obese. Obesity cost the USA $190.2 billion in
2018, accounting for 21% of healthcare expenses. The
government continues investing much money in healthcare
institutions to provide the most excellent care to patients, and
the economic implications are enormous.
At the community level, obese patients experience
difficulties managing the physical, emotional, and financial pain
associated with obesity. Financially, community members spend
a lot on treating and managing the disease. The frequent
hospital admissions have caused financial implications because
they do not go to work often. Some have to incur an extra
financial cost because they need to employ a caregiver at home.
The disease is emotionally draining, and patients are at
increased risk of developing panic disorder, bipolar disorder,
and major depression. The number of obese patients at the
clinical site was significant, calling for an innovative
intervention to reduce obesity and enhance clinical
outcomes.Theory or Translational Science Framework past tense
The Knowledge to Action Framework served as a framework for
the integrative review. It was developed by Dr. Ian Graham and
his colleagues in 2006 and was founded on over thirty theories
of change. It gives a seven-phase cycle that allows stakeholders
to translate knowledge into practice to enhance outcomes
(Graham & Tetroe, 2010). The model comprises two essential
parts: knowledge generation and action. This model's primary
purpose is to turn evidence into action while monitoring,

evaluating, and tweaking the implementation process (Bossart et
al., 2020). The seven phases in the Knowledge to Action
Framework will serve as a structure and guide for this
integrative review.
The first phase of the Knowledge to Action (KTA) model is to
identify
the problem. The problem should be determined to
inform the most appropriate tool. The practice problem, in this
case, is an increasing prevalence of obesity which needs urgent
intervention. The AHA Diet and Lifestyle Guidelines are a
relevant tool used to prevent and reduce the prevalence of
obesity.
The second phase is to adapt knowledge to the local context.
There is a need to identify available stakeholders in the local
context, including available healthcare providers, nurse
managers, and patients. The stage also involves building a
robust infrastructure in the local context and linking the local
context to other model locations.
The third phase is to assess facilitators and barriers to
knowledge use.
This stage involves identifying facilitators to change
and the obstacles that may drag the process or reduce the
outcomes (Kitson et al., 2018). The location is essential as it
helps stakeholders utilize the facilitators and address the
barriers. The facilitators include a cooperative patient care
team, and the potential wall is that participants may forget to
input data in the tracking app and others lack proper mobile
access. The challenges can be addressed by educating patients
and sending weekly reminders.
The fourth stage is to select, tailor, and use knowledge
. The step involves mapping and applying the AHA diet
and lifestyle recommendations and using the tracking app to
ensure compliance in the best way possible.

The fifth phase is to monitor knowledge use. Collecting data on
knowledge use is essential and providing the service aligns with
the project purpose (Bryant et al., 2019). It will help
stakeholders make some changes if needed to facilitate the
project.
The sixth phase is to evaluate the outcomes.
It is vital to assess the effects of the strategy
intervention to inform future decisions. Intervention evaluation
helps determine if any goals should be addressed to enhance the
project outcomes (Zhao et al., 2021). The DNP student may
evaluate the results by interviewing patients and the patient’s
care team. Internal sources may also include weight changes, as
evident in the clinic’s data.
Phase seven of the KTA model is to sustain knowledge. There
should be strategies for supporting evidence-based knowledge
to enhance and impact the current practice. Knowledge
implementation is more effective if it is maintained for a long
time. To sustain long-term weight control, nutrition knowledge,
attitudes, and dietary self-regulation are significant predictors
of overweight and obesity (Balani et al., 2019).Methodology
Review Protocol
The search for appropriate literature was centered on key terms,
concepts, and phrases, including obesity care, physical activity
and obesity, lifestyle implications, and activity trackers. The
primary databases where the resources were drawn are
Chamberlain Library, CINHAL, and PubMed. Studies conducted
for the preceding 4-5 years were included in the search. During
the initial search, 20000 articles were found, and only 45 were
selected based on the relevance and availability of the entire
study online for further examination. The 45 studies were then
filtered down to 15 more appropriate studies to answer the
PICOT question.
The search started by defining the PICOT question and

narrowing it down to the focus: The AHA lifestyle
recommendations and obesity. After having searchable
questions, the keywords and phrases that can express the two
concepts were determined. A concept map was then developed
to guide the search process by showing the relationship between
the key terms or concepts in the PICOT question. After defining
the searchable question and having the relevant keywords,
phrases, and concepts, the databases with a broad range of
evidence were determined, and the search process began.
The search strategy accounted for all possible search terms,
keywords, and key phrases that could help yield results that
answer the PICOT question. The search was done using
keywords, exact phrases, and adjacency which yielded more
relevant results. Article titles were also used to search for
known key papers used in developing the project plan. At the
end of the initial search, many results were produced, and the
next step was to make the search comprehensive. The
appropriate filters, relevance, and currency were used to filter
the yield and arrive at the 15 articles used for the review.
Comment by McGonigal, Shelly (AHN): What were the
appropriate filters? This section is good but lacks detail into
how you filtered/adjusted key terms to get to
15Inclusion/Exclusion Criteria past tense
The types of studies and levels of evidence played a significant
role in determining what should be included in the study. The
project relied on levels I, II, and III of evidence to get high-
quality and justifiable findings based on high-quality research
designs. The types of evidence included in the review can be
grouped into the following: experimental studies, RCTs,
Systematic Analyses and Meta-analyses of RCTs, and
observational studies. These study designs yield objective, high-
quality information that can be successfully implemented.
Evidence from opinions and single descriptive studies were
excluded from the study. Comment by McGonigal, Shelly
(AHN): This section is good - just need more detail What

years did you include/exclude; demographics? Full text?
Journals? White Papers? Etc. Comment by McGonigal, Shelly
(AHN): This is an integrative review - not a study - please
adjust
The studies included in this review are those with realistic,
practical recommendations. The recommendations must be
aligned with the investigated problem and whether the
interventions can be implemented successfully in terms of
dosage, method of implementation, and the time it takes to
implement the intervention. For example, it may be unrealistic
to recommend interventions that take more than five years to
evaluate and determine outcomes. Studies whose
recommendations seemed unrealistic or required too much time
for implementation were excluded.
The last criteria were credibility, currency, and relevance. The
study included sources that have been published in credible
journals and credible authors. They must also be relevant
because their findings directly relate to the project problem.
Lastly, the sources were analyzed in terms of currency to ensure
the data extracted are current and can be used to address current
problems. Sources whose credibility was questioned, published
more than five years agow, and do not directly address the
PICOT question were excluded. Comment by McGonigal,
Shelly (AHN): Need years...
Data Analysis
After defining the question and identifying studies that meet the
criteria for review, data were extracted by reading through the
studies and summarizing the relevant findings. While reading
through the studies, it was essential to identify any possible
biases that would compromise the quality of the study. During
summarization, the meaning was attached to the findings
through critical interpretation, and the summary findings were
input into the John Hopkins evidence table for easy analysis.
Comment by McGonigal, Shelly (AHN): Did you use a tool
for the analysis of the articles? John Hopkins Nursing evidence
based practice tool? Good work - just light on detail.

After all the data was extracted, a qualitative approach was used
to analyze the findings. The approach involves collecting
descriptive, non-numerical data to help understand experiences,
concepts, experiences, and opinions. The qualitative approach
was used to gather in-depth insights into the problem and
generate ideas to help address the PICOT question. The choice
of qualitative data analysis was informed by its ability to define
critical points from several studies and summarize them into
meaningful data. Qualitative analysis also gives room for in-
depth examination, a feature that may not be present in
quantitative analysis (Agunis & Solarino, 2019). Through
qualitative data analysis, the review yielded findings related to
the effectiveness of AHA recommendations, the use of
technology, and factors that can influence better intervention
outcomes.
A thematic analysis approach was used to analyze the data
and generate results from themes relevant to the project. The
analysis was conducted in three main steps; familiarization with
data, identifying common themes across several studies,
grouping all the findings related to specific themes, and putting
down all the findings in a synthesis form. The approach is
advantageous because it enables one to understand the patterns
in data and find relevant findings that will address the research
problem. It is also a straightforward approach that consumes
less time.Results and Discussion
Characterization of the Body of Literature
The integrative review was based on high-quality resources,
credible research designs, appropriate participants, and realistic
and ethical recommendations. The evidence types included
experimental designs, RCTs, systematic reviews, and
observational studies. The sources were published in credible
sources, including the
American Association of Nurse Practitioners, the
American Psychological Association, the Journal of Digital
Health and Open Science, and the Journal of Public Health.

The literature sources were drawn from Chamberlain Library,
CINHAL, and PubMed. The three were chosen because of their
credibility, as most of the articles in these databases are
authentic. After the initial search, about 2,000 articles surfaced,
which called for further review to come up with sources that
addressed the PICOT question. Therefore, the DNP student
narrowed the search to key terms and concepts and exact
phrases so that the results were filtered to more relevant ones.
After using keywords and phrases, the search was filtered to 45
papers only. Further, other mechanisms such as type of research
design, currency, and relevance to the project were used to
review, and in the end, 15 sources were used for the review. The
DNP student felt the 15 would better address and answer the
PICOT question.
The Strengths of the resources were examined, and it was found
that the sources used for the integrative review are credible,
authored by professionals, and published in trusted journalsw.
They provided comprehensive, precise, and reproducible data
that stated measurable outcomes. In all the sources, the
observable outcomes were evident. Comment by McGonigal,
Shelly (AHN): Which journals?
The review relied on RCTs that test the relationship between
cause and effect. The findings from the RCTs have minimal bias
and help to establish a direct outcome of the lifestyle
interventions. RCTs also administer interventions in a
controlled way which enhances the effectiveness of the
research.
The studies were based on reliable data collection and analysis
methodologies, contributing to the research's overall quality.
The studies were analyzed using statistical methods or
qualitatively and bore insightful results. Strict eligibility
criteria were used to ensure that the sources used were credible
and of high quality. Only studies levels I, II, and III were used,
implying that the findings are credible.
The weaknesses of the resources were examined, and it was

found that one of the most common limitations of studies is the
risk of subjective bias at different stages of the research. The
sources are evidence of subjective biases during study design,
data collection, and analysis. Some systematic errors may affect
the quality of the studies.
Most studies were conducted in specific populations, making it
challenging to generalize and apply the findings in a different
setting. It makes it challenging to establish the extent to which
the results can be applied in a broader context. As a global
problem, obesity should be approached from a broader
perspective. The results of a specific population in one part of a
country may not represent all the patients.
Detail is required – Check on page requirements – this section
appears to be short. More specifics…Findings Synthesis past
tense
The studies yielded significant evidence that helped to answer
the PICOT question and what can be incorporated in practice to
enhance healthy living and boost the quality of life. Researchers
have identified lifestyle interventions and practices that can be
implemented to prevent and manage obesity. Research done by
Balani et al. (2019) points out that self-regulation is the first
step to managing weight and living healthily. Self-regulation
entails consuming the right amount of food at the correct
intervals to avoid being overweight. Wadden et al. (2020) share
the same sentiments and maintain that people who regulate the
amount of food intake are likely to be healthier and prevent
obesity and other diseases associated with lifestyle. Such
patients are less vulnerable to obesity, especially if they are
free from other linked factors, such as genetics. Comment by
McGonigal, Shelly (AHN): Integrative review Comment by
McGonigal, Shelly (AHN): What were the key themes from the
articles - synthesize the findings
Researchers also emphasize that food intake self-regulation,
coupled with physical activities, is likely to enhance the quality
of life. In their study, Wadden et al. (2020) also mention that

engaging in physical activities, such as exercising, leads to
long-term weight loss, making people healthier and less obese.
As people exercise, they burn calories in the body, which
results in weight loss. The findings are emphasized by Swift
(2018), who reveals that exercising and training have solid
clinical significance and reduces obesity. For people who are
already battling medical issues, exercises and training exercises
help manage the issue. However, Beauchamp (2018) insists that
patients should be monitored and supported to enhance
outcomes. In his study, Beauchamp reveals that patients who are
supported and monitored are more likely to adhere to healthy
behavior than those who are not monitored or supported.
Monitoring also helps to identify any issues that may hinder
effectiveness and address them as soon as possible.
Evidence from the sources also shows that lifestyle
interventions are significant in weight management, and
implementing these interventions contributes to healthy living
in the community. Jerome (2019) conducted a study that
revealed that lifestyle modifications are clinically significant
and reduce incidences of obesity when implemented
appropriately. Balani et al. (2019) conducted an online survey
that revealed that people who regulate food intake in their
bodies are in a better place to attain and maintain a clinically
appropriate weight. In a different study, Bergum (2021)
mentions that lifestyle interventions reduce blood pressure and
control weight gain. Patients who can control weight
automatically become less vulnerable to obesity. However,
these researchers also raise concerns about the effectiveness of
lifestyle interventions on obesity, saying that they may not
directly affect the amount of cholesterol in the body. The
concerns are built on the basis that the effectiveness of a
lifestyle intervention depends on many other internal and
external factors.
Jiang (2022) also found out that patients who receive lifestyle
interventions reduced the risk of obesity and enhanced their
quality of life. While Wadden et al. (2020) acknowledge the

role of physical training in weight management and long-term
weight loss, the researchers found that patients require face-to-
face sessions where they are counseled and motivated to remain
on track. The researchers mention that online monitoring is less
effective because it encourages non-adherence, and patients may
not report the actual progress. When patients meet in a physical
setting, they exchange ideas and progress, challenging each
other to stay on track. On their part, Swift et al. (2018)
challenge patients to incorporate diet and physical activities
together, saying they are more effective when implemented
together compared to when either of them is implemented. Swift
and colleagues also argue that 150 minutes and 75 minutes for
moderate and vigorous exercise are insufficient to make a
clinical difference.
Lean et al. (2018) also conducted a study that revealed that
dieting and physical activities significantly prevent and manage
type 2 diabetes. The researchers conducted a Randomized
Control Trial (RCT) where more than half of the participants
recorded positive results after 12 months of an intensive weight
management program that included physical activity and
dieting. After the program, these patients attained remission of
type 2 diabetes and were freed from antidiabetic drugs.
Therefore, the researchers concluded that lifestyle health
management effectively prevents and manages lifestyle
diseases. In a randomized control trial conducted by Groessl
(2019), physical activity intervention addresses long-term
negative implications associated with obesity, such as reduced
mobility; obese patients who engage in physical activity are less
likely to experience mobility issues compared to those who do
not. The researcher mentions that while patients may have
trouble treating obesity thoroughly, they can manage obesity-
related complications through healthy lifestyles.
Apart from dieting and physical activities, researchers have
acknowledged the significance of technology in using the AHA
recommendations to manage weight and attain a high-quality
life. As the healthcare system embraces technology, researchers

also continue to assess how patients can benefit from the latest
technological tools and applications. One of the technological
tools is wearable trackers that have positive and negative effects
on implementing AHA recommendations. According to
Brickwood et al. (2019), patients who use wearable trackers
when exercising are likely to increase their step count over time
as they get motivated. However, according to the study, the
motivation will depend on other internal and external factors,
such as tolerance, state of mind, and weather conditions. For
example, patients with a high tolerance are more prone to
continue working than those with a low tolerance. Similarly,
poor weather conditions, like a rainy evening, may discourage a
patient from jogging. In the same study, the researchers
revealed that wearable trackers increase monitoring, enhancing
patients’ ability to monitor their progress.
Following et al. (2019) conducted a qualitative study that
identified trackers as enhancers and distracters in patients’
participation. According to the researchers, the trackers act as
either success or failure proof which may motivate or
demotivate patients. When a tracker records positive progress,
patients will likely be motivated and continue with the
interventions. Similarly, a systematic review conducted by Gal
(2018) shows that wearable trackers and phone applications are
practical tools that encourage patients to continue exercising
and training through successful monitoring. On the contrary,
patients may stop exercising if the tracker records zero or
negative progress. The researchers recommended individualized
trackers that meet clients’ needs to avoid discouragement. Gal
et al. (2019) revealed similar results: a tracker can promote or
inhibit physical activities among patients. Gal and her
colleagues recommend that patients have other forms of support
and motivation to maintain a healthy lifestyle.
The two preceding studies acknowledge that trackers can
promote engagement in physical activities, but they depend on
other external factors. Therefore, it is crucial to check on all
factors before ascertaining the impact of the trackers. For

example, clients who are less willing to use the tracker may
yield minimum benefits even when they use them. The aspect of
willingness and acceptability has been researched by
Vandelanotte et al. (2020), who reveal that clients’ acceptability
and willingness to track their progress enhances or reduces
intervention outcomes. More willing and accepting users are
more likely to benefit from the trackers than those who are
unwilling. The authors, therefore, challenge patients to embrace
trackers and use them appropriately to be a source of
motivation. On his part, Hu (2021) maintains that connectivity
also determines the outcomes of the interventions concerning
patients’ ability to stay in touch with mentors who keep
engaging them and updating their progress. However, he
maintains that self-tracking apps are easy to use, and if patients
are willing, they will register positive outcomes.
Researchers went further to determine the internal and external
factors that may enhance the outcomes of lifestyle intervention.
These factors are likely to make a positive difference when
incorporated into practice. In research conducted by Balani et
al. (2019), patients' attitudes and nutrition knowledge affect
their ability and willingness to stay committed to intervention
programs. Patients knowledgeable about nutrition and have
positive attitudes toward weight management are likely to be
more committed to the programs and achieve positive results.
The study authors, therefore, challenge healthcare institutions to
invest in patients’ knowledge and attitudes which they believe
will enhance outcomes. In another study, Ma (2017) attributed
the lack of positive outcomes to a lack of or poor assessment,
which demotivates patients and makes them return to their
unhealthy lifestyles. The researcher argues that frequent
evaluation of the interventions will help keep patients on track
and enhance outcomes and determine any gaps that can be fixed
to enhance outcomes.Conclusions and Further
Recommendations
Implications for Nursing Practice past tense

Primary clinics should incorporate the AHA recommendations
as part of the treatment plan protocols to enhance patient
outcomes. Healthcare professionals should educate patients on
the importance of healthy living and provide them with the
necessary support, such as remote monitoring, to ensure they
can sustain positive outcomes. There should be efforts that
enhance adherence, such as personal sessions to encourage the
patients to eat appropriately and engage in physical activities to
attain and maintain an appropriate weight. By doing this,
patients' overall quality of health will improve, and they will
incur fewer costs in treating and managing diabetes.
In nursing care, there should be efforts to address obesity by
incorporating diet and healthy lifestyle recommendations, such
as offering patients the right nutritional foods with the right
amounts of calories needed. There should be time for physical
activities, such as evening walks, as patients can improve their
general quality of life and treatment outcomes. Nursing care
today should be done holistically, meeting patients' physical,
mental, nutritional, and emotional needs to avoid over-relying
on medications alone which, in some cases, may not register
positive outcomes. These efforts will result in reduced hospital
stays, enhanced patient outcomes, and better job satisfaction
among healthcare professionals.
At the organizational level, healthcare institutions should
embrace lifestyle interventions and develop treatment plans
incorporating lifestyle aspects to cut costs. Remote monitoring
of patients about adhering to lifestyle intervention should also
be implemented to reduce admission rates and hospital check-
ins, as this will reduce daily hospital costs. Therefore, facilities
should embrace technology and utilize modern tools to improve
telehealth and reduce costs while maximizing outcomes.
Check the requirements for this section – micro/meso
impact?Conclusions and Contributions to the Professions of
Nursing past tense
Obesity is a significant individual, community, national, and

global healthcare problem. According to research, lifestyle
interventions effectively manage appropriate body weight and
prevent obesity (Wadden et al., 2020). People who implement
dieting and physical exercises are more likely to achieve long-
term weight loss than those who do not (Swift et al., 2018). The
integrative review found that incorporating regular physical
activity and a healthy diet help to diminish multiple medical
issues connected with obesity (Bray & Ryan, 2020), reducing
the expenses associated with obesity treatment for
organizations, which improves clinical results and nursing care.
This systematic review supported the effectiveness of the AHA
Diet and Lifestyle recommendations to prevent and reduce
obesity, and clinical use is recommended as an innovative
solution. The lifestyle recommendations are practical, as
Bergum et al. (2018) revealed that patients who incorporate
healthy eating and exercise register low body weight. However,
the interventions are more effective if followed by face-to-face
counseling to enhance outcomes (Wadden et al., 2020).
Interventions are also more effective than dieting or physical
exercises alone (Swift al., 2018). Swift is further concerned that
150 minutes for moderate exercise and 75 minutes for vigorous
are inadequate to make a clinical difference.
Researchers further acknowledged technology's role in
implementing AHA diet and lifestyle recommendations. Clients
who use wearable trackers become more motivated and register
more steps in physical exercise (Brickwood et al., 2019).
Similarly, Gal et al. (2019) and Vandalanotte et al. (2020)
reveal that wearable trackers enhance engagement in physical
activity. However, the researchers further show that wearable
trackers are more effective if patients are willing to use them
and if they can access customized trackers that meet their
needs.Recommendations Do not bullet – must be in paragraph
form
·
Because obesity is a prevalent disease, primary care

clinics must devise a plan to address this chronic illness.
· Healthcare professionals and other stakeholders should
educate patients on the importance of lifestyle interventions to
enhance their acceptability of dieting and physical activity.
· Nurses should incorporate lifestyle interventions in their daily
care plans to enhance treatment outcomes.
· Patients should also embrace healthy living as a prevention
and management mechanism for obesity and other lifestyle-
related diseases. They should be committed to the intervention
to enhance intervention outcomes.
· Patients should embrace wearable trackers and mobile
applications to help them monitor their physical activity
progress and use them as a motivation to adhere to healthy
living.
· Future researchers should consider examining the
effectiveness of the knowledge-to-action implementation model
in implementing AHA recommendations for obesity prevention
and management. Examining this model will help establish the
most appropriate population for this implementation approach.
·
Researchers should also address the limitations of the
research designs in this review to enhance the quality of the
data extracted. First, there is a need to research different
participants and geographical areas to enhance the
generalizability of the research findings. Future researchers
should also minimize subjective bias as much as possible to
enhance objectivity, enhancing the research quality.
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(2019). Nutrition knowledge, attitudes, and self-regulation as
predictors of overweight and obesity.
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Beauchamp, M. R., Ruissen, G. R., Dunlop, W. L., Estabrooks,
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Puterman, E., Sheel, A. W., & Rhodes, R. E. (2018). Group-
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11
Appendix A
Johns Hopkins Nursing Evidence-Based Practice
Individual Evidence Summary Tool
© The Johns Hopkins Hospital/Johns Hopkins University. It
may not be used or reprinted without permission.
Practice Question: In overweight adult patients in a primary
care clinic, what is the impact of implementing the American
Heart Association Diet and Lifestyle recommendations,
compared to standard care, on body weight in 8-10 weeks?
Date: 11/10/2022
Article Number
Author and Date
Evidence Type
Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures

Limitations
Evidence Level, Quality
1
Balani, 2019. https://doi.org/10.1097/JXX.0000000000000169
Experimental study.
A total of 313 adults participated in an online survey.
-Poor eating self-regulation enhances weight gain.
-Nutrition knowledge and attitudes matter.
Examine knowledge and attitudes.
Possibility of subjective bias.
Level II, Good.
2
Beauchamp, 2018. https://doi.org/10.1037/hea0000615
Randomized controlled trial (RCT).
Enrolled 627 older adults, conducted in Greater Vancouver,
Canada, using two group-based exercise programs for older
adults.
-Provide support for the efficacy of group-based physical
activity programs.
-Promotes exercise adherence behavior.
Efficacy of group-based physical activity programs.
Validity depends on multiple sites.
Level I, High.
3
Bergum, 2021 https://doi.org/10.1186/s12872-021-01989-5
Systematic Review and Meta-Analysis of the randomized
controlled trial (RCT).
Six thousand three hundred fifty patients from three
geographical regions; North America (6 trials), Western Europe
(5 shots), and Oceania (1 trial).
-Lifestyle recommendations reduce blood pressure.

-Lifestyle interventions do not have a significant impact on
cholesterol.
Efficacy of lifestyle intervention.
Subjectivity bias.
Heterogeneity.
Level I, Good.
4
Brickwood, 2019. https://doi.org/10.2196/11819
Systematic Review and Meta-Analysis.
A random-effects meta-analysis was completed on seven
studies that reported changes in sedentary behavior.
-Consumer-based wearable trackers enhance monitoring and
support and increase physical activity participation.
Effects of consumer-based wearable activity trackers.
Risk of bias.
Level I, Good.
5
Following, 2021. https://doi.org/10.1186/s13102-021-00253-9
Observational study.
Twenty-nine informants (aged 21 to 66 years) were interviewed;
59% were female.
-Activity monitors can enhance or undermine weight-loss
programs.
-Individualized monitors work better.
Patients’ experiences.
Does not demonstrate causality.
Prone to bias.
Level III, Good.
6
Gal, 2018. https://doi.org/10.1186%2Fs40798-018-0157-9
Systematic Review and Meta-Analysis of the randomized
controlled trial (RCT).
Eighteen studies were included in this review. The included

studies involved 2734 participants from different populations.
-Wearables and smartphone applications promote physical
activity among adults.
Effects of physical activity.
Risk of bias.
Level II, Good.
7
Groessl, 2019. https://doi.org/10.1016/j.amepre.2018.09.006
Multisite RCT compared physical activity to health education
among 1,635 randomly assigned sedentary older adults at risk
for mobility disability.
- Physical activity interventions can slow the decline in quality
of life.
Activity interventions
Risk of bias.
Level I, High.
8
Hu, 2021.
Among 135 participants included in the analysis, the median
attendance rate for the 14 remote sessions was 85.7%.
-Connectivity is a great challenge in remote monitoring.
-Self-monitoring apps are easy to use.
Describe challenges and lessons.
Low external validity.
Level I, High.
9
Jenum, 2019. https://doi.org/10.1007/s00125-019-4905-2
Meta-analysis of RCTs.
Individual participant data on 1816 participants from all six
eligible RCT trials (four from Europe and two from India).
- lifestyle modification interventions in high-risk South Asian

populations resulted in a clinically significant 35% relative
reduction in diabetes incidence.
Lifestyle modification interventions.
Limited generalizability.
Level I, High.
10
Jiang, 2022. https://doi.org/10.20945/2359-3997000000441
Meta-analysis of RTCs.
Thirteen RCTs involving 3376 individuals with diabetes or
prediabetes were selected for this meta-analysis.
- Risk of diabetes was significantly reduced in individuals who
received lifestyle interventions and were associated with lower
glucose dysregulation.
Investigate the role of lifestyle interventions on glucose
regulation and delay the onset of diabetes in adults.
Level I, High.
11
Lean, 2018. https://doi.org/10.1016/S0140-6736(17)33102-1
Three thousand six individuals from 9 primary care practices in
Scotland and the Tyneside region of England were randomly
assigned (1:1) via a computer-generated list.
-Intensive weight management programs helped to achieve
remission of type 2 diabetes.
Assess the impact of intensive weight management.
Level I, High.
12
Ma, 2017. https://doi.org/10.1136/bmj.j4849
Systematic review and meta-analysis of randomized controlled
trials (RCTs).
54 RCTs with 30 206 participants were identified.
- high-quality evidence showed that weight loss interventions

decrease all-cause mortality.
Assess the impact of weight loss interventions.
Risk of bias.
Level I, High.
13
Swift, 2018
https://doi.org/10.1016/j.pcad.2018.07.014
Systematic Review of RTCs.
Evaluated weight loss from exercise training programs (ET)
composed of aerobic training, resistance training, and programs
that combine diet and ET.
-Minimum requirements for exercise are not clinically
significant for weight loss.
-Combination of exercise and diet leads to better outcomes.
Effects of exercise and physical activity.
Susceptible to bias.
Level III, Good.
14
Wadden, 2020.
https://doi.org/10.1037/amp0000517
Systematic Review of RTCs.
Evaluate ten articles that reflect the contributions of multiple
psychologists to the development and treatment of obesity in
children, adolescents, and adults.
Face-to-face counseling sessions are practical.
High levels of physical activity and reduced calorie
consumption.
Effects of intensive behavioral interventions.
Lacks generalizability.
Level III, Good
15
Vandelanotte, 2018.
https://www.jmir.org/2018/12/e11321?rel=0

Randomized controlled Trial (RTC).
A total of 243 Australian adults participated.
Fitbit activity trackers increase total weekly activities.
Effectiveness of web-based computer-tailored intervention.
Validity depends on multiple sites.
Level I, High.
Reduce Obesity
Yuritza Medina
Chamberlain College of Nursing
NR709 Project and Practicum IV
Summer 2022
Abstract Past tense
The prevalence of obesity and sedentary lifestyle complications
i at alarming rates, representing a common but preventable
cause of severe medical complications like diabetes,

cardiovascular diseases, and early mortality. This common but
chronic condition has been for a long time a public health
concern and social determinant. The integrative review focused
on how the American Heart Association (AHA) Diet and
Lifestyle recommendations and the Fitbit app are used as
innovative solutions to reduce obesity in adult patients. The
Fitbit app offers a unique opportunity to enhance the efficacy of
weight loss plans, as it is used to track activity, The prevalence
of obesity and sedentary lifestyle complications increased at
alarming rates. This common but chronic condition represented
a common preventable cause of severe medical complications
like diabetes, cardiovascular diseases, and early mortality. The
integrative review focused on the American Heart Association's
(AHA) diet and lifestyle recommendations and the Fitbit app as
an innovative solution that reduced obesity and enhanced weight
loss efficacy.monitor steps, heart rate, energy expenditure,
sleep, and sedentary behavior.
Research Methodology: This integrative review was based on
researched articles completed from 2017 to 2022, that were
centered on obesity care, diet, physical activity, activity
trackers, and lifestyle implications for adults. The databases
searched were chamberlain library, PubMed, and CINHAL. The
15 papers most relevant to the PICOT question were studied in
further detail and appraised using the Johns Hopkins Evidence
Appraisal table.
A systematic review was conducted to identify research articles
completed in the preceding 4-5 years centered on obesity care,
diet, physical activity, activity trackers, and lifestyle
implications. The databases searched were Chamberlain Library,
PubMed, and CINHAL.
ResultsResults and Discussion: The DNP student conducted a
comprehensive search of academic databases for primary
research published from 2017 to 2022. The key themes were
obesity and lifestyle recommendations. It yielded over two
thousand articles, of which 45 fitted the integrative review's

theme, and from there, 15 were chosen and examined in detail.
Of these, 1 was an experimental study, 1 was an observational
study, and the rest 13 were randomized controlled trials. Initial
searches yielded over 2000 articles, of which 45 were chosen
and examined because they fit the integrative review's theme.
The 15 papers most relevant to the PICOT question were studied
in further detail and appraised using the Johns Hopkins
Evidence Appraisal table. All tThe studies reported positive
physical activity outcomes. What were the key themes?
Conclusions and Further Recommendations:This systematic
review supported that te effectiveness of the AHA Diet and
Lifestyle recommendations to prevented and reduced obesity,
and general clinical use wasis recommended. Fitbit app apps
provides new ways to improve physicalenhanced physical
activity habits, and the easy availability of electronic devices
enhancedaugmented their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle
recommendations; Obesity management; Lifestyle
recommendations; Physical activity interventions using Fitbit
activity trackers.
Dedication
In dedication to my family for their steadfast support of this
project; their cooperation means a lot to me. To my husband
Armando, thank you for your love, understanding, and patience
during this time. I credit my achievement to all of you for your
unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors from
Chamberlain University, who inspired, encouraged, and
supported me throughout the DNP program. My heartfelt thanks

to my teammates, without whom I would never have completed
this phase in my life. Their encouragement has had a significant
influenceconsiderable influence on my strong determination
during this trip.
Contents
Reduce Obesity 1
Abstract 2
Dedication 3
Acknowledgments 4
Introduction 6
Problem Statement 7
Significance of the Practice Problem 7
Theory or Translational Science Framework 8
Methodology 10
Review Protocol 10
Inclusion/Exclusion Criteria 11
Results and Discussion 13
Characterization of the Body of Literature 13
Findings Synthesis 15
Conclusions and Further Recommendations 20
Implications for Nursing Practice 20
Conclusions and Contributions to the Professions of Nursing 21
Recommendations 22
References 23
Appendix A 28
1
5
Reduce Obesity

ObesityObesity was reported by WHO (2021) and CDC (2021)
as a global epidemic that impacted an estimated 650 million
individuals worldwide and has caused 2.8 million deaths
annually. Despite the efforts made to prevent and manage
obesity, patient numbers increased, and in the USA alone,
yearly, more than 300,000 deaths were recorded (CDC, 2021).
Also, the emotional, social, financial, and other implications
that this serious health concern has at a patient, community,
national, and international level were huge. The AHA
recommended lifestyle interventions that reduced the prevalence
of obesity and made people live within the clinically
appropriate weight (Bray & Ryan, 2020). The recommendations
were found in literature and practice, but few researchers have
analyzed the literature on the effectiveness of these
interventions. wasis a global epidemic that impacts an estimated
650 million individuals worldwide, causing 2.8 million deaths
annually (WHO, 2021; CDC, 2021). Despite efforts to prevent
and manage obesity, the numbers are still increasing, and in the
USA alone, more than 300,000 deaths are recorded yearly
(CDC, 2021). Also is devastating the emotional, social,
financial, and other implications that this serious health concern
has at a patient, community, national, and international level.
The AHA recommends lifestyle interventions that can reduce
the prevalence of obesity and make people live within the
clinically appropriate weight (Bray & Ryan, 2020). The
recommendations are found in literature and practice, but few
researchers have analyzed the literature on the effectiveness of
these interventions.
Wearables and smartphone applications provided new ways to
improve improve physical activity habits (Gal et al., 2018), and
researchers hahadve further acknowledged technology's role in
enhancenhancinging these interventions' outcomes. This
integrative review presented quality and credible sources that
established evidenceevidence of the efficacy of the AHA Diet
and Lifestyle recommendations to reduce reduce and prevent
prevent obesity in adult patients. Also, demonstrated the role of

wearable trackers and mobile applications and what can be done
to enhance in enhancing the effectiveness of these interventions
werewas analyzed. The review started by defining the problem,
its significance, and the translation framework that served as its
foundation. The DNP student discussed the methodology,
capturing the review protocol, how studies werewere included
or excluded, and how data waswas analyzed. Further, the DNP
student characterized the body of literature used in the review
and later synthesized findings that informed the
recommendation of the AHA lifestyle interventions to reduce
weight.Problem Statement past tense
ObesityObesity representrepresentss a common but preventable
cause of morbidity and severe medical complications (WHO,
2021). Despite efforts efforts to curb the issue, globally, the
annual cases of obesity continued to rise, affecting people's
health (CDC, 2021; Carbone et al., 2022). According to the
literature, for patients with obesity or a sedentary lifestyle,
physical activity and a healthy lifestyle areare advised to
minimize the risk of chronic diseases such as diabetes,
cardiovascular disease, and cancer (Lavie et al., 2019). The easy
availability of sophisticated activity trackers such as Fitbit
offers a unique opportunity to use it to improve physical
activity habits (Gal et al., 2018). These advanced activity
trackers can monitored steps, heart rate, energy expenditure,
sleep, sedentary behavior, and physical activity intensity
(Vandelanotte et al., 2018). The inquiry question which
provided direction for the integrative review waswas: In
overweight adult patients in a primary care clinic, what isis the
impact of implementing the American Heart Association Diet
and Lifestyle recommendations, compared to standard care, on
body weight in 8-10 weeks?Significance of the Practice Problem
past tense
Obesity has become a global epidemic, with at least 2.8 million
people dying yearly from beingbeing overweight or obese

(WHO, 2021). Obesity has several negative consequences for
population health and healthcare costs (Carbone et al., 2022).
Sedentary behavior and physical inactivity wereare two of the
most common modifiable risk factors in obese patients. Obesity
isare a chronic condition linked to higher mortality and
morbidity rates (WHO, 2021). According to the Centers for
Disease Control and Prevention, it causeds an estimated 300,000
fatalities yearly in the United States (CDC, 2021). Obesity co-
morbidities, include including heart disease, stroke, type 2
diabetes, and some kinds of cancer, contributeding to a lower
quality of life and shorter life expectancy. Obesity
affectaffecteds 93.3 million persons in the United States and
had representedis one of the primary causes of avoidable and
early mortality (CDC, 2021).
At the national level, the rate of obesity-related diseases
representeds a severe public health concern that negatively
impacteds the community's quality of life and nursing care
expenses. According to the CDC 2021, obesity wasis a common,
powerful, and costly disease, and the prevalence and incidence
remained high in the United States. The Centers for Disease
Control and Prevention (CDC) reporteds that 42.4% of all adults
in the United States wereare fat, and 650 million individuals
worldwide wereare obese. Obesity cost cost the USA $190.2
billion in 2018, and accounteding for 21% of healthcare
expenses. The government continuecontinueds investing much
money in healthcare institutions to provide the most excellent
care to patientsprovide patients with the most excellent care,
and the economic implications wereare enormous.
At the community level, obese patients experienced
difficulties managing the physical, emotional, and financial pain
associated with obesity. Financially, community members were
spended a lot on treating and managing the disease. The
frequent hospital admissions have caused financial implications
because obese patientsthey looseddo not go to days of work
often. Some patientshave to incurincurred extra financial costs
related to the need an extra financial cost because they need to

employ of a caregiver at home. The disease causedis
emotionally drainindrainedg, and patients reportedare at
increased risk of developing panic disorder, bipolar disorder,
and major depression. The number of obese patients at the the
clinicals site waswere found to be significant, calling for an
innovative intervention to reduced obesity and enhance enhance
clinical outcomes.Theory or Translational Science Framework
past tense
The Knowledge to Action Framework served as a framework for
the integrative review. It waswas developed by Dr. Ian Graham
and his colleagues in 2006 and waswas founded on over thirty
theories of change. It gaveives a seven-phase cycle that
alloweds stakeholders to translate to translate knowledge into
practice to enhance enhance outcomes (Graham & Tetroe,
2010). The model comprises two essential parts: knowledge
generation and action. This model's primary purpose is was to
turned evidence into action while monitoring, evaluating, and
tweaking to turn evidence into action while monitoring,
evaluating, and tweaking the implementation process (Bossart et
al., 2020). The seven phases in the Knowledge to Action
Framework will serve as a structurewere structured and guide
guided for this integrative review.
The first phase of the Knowledge to Action (KTA) model iswas
to identifidentifyy
the problem. The problem wasshould be determined to
inform inform the most appropriate tool. The practice problem,
in this case, iswas an increaseding prevalence of obesity which
neededs urgent intervention. The AHA Diet and Lifestyle
Guidelines arewere a relevant tool used thato prevent prevented
and reduce reduced the prevalence of obesity.
The second phase isserved to to adapted knowledge to the local
context. There iwass a needed to identify identify available
stakeholders in the local context, includingavailable

stakeholders in the local context, including available healthcare
providers, nurse managers, and patients. The stage also
involveds building a robust infrastructure in the local context
and linking it to other model locations' local contextslinking the
local context to other model locations.
The third phase iwass to assess assess facilitators and barriers
to knowledge used.
This stage involveds identifyeding facilitators to
changed and the obstacles that may draged the process or
reduced the outcomes (Kitson et al., 2018). The location iswere
essential as it helpeds stakeholders utilize the facilitators and
addressed the barriers. The facilitators included a cooperative
patient care team, and the potential wall iswere that participants
may forgoet to input data in the tracking app and others lacked
proper mobile access. The challenges were can be addressed by
educated ing patients and sendeding weekly reminders.
The fourth stage iswere to selected, tailor, and used knowledge
. The step involveds mapping and applying the AHA
diet and lifestyle recommendations and useding the tracking app
to ensured compliance in the best way possible.
The fifth phase iswere to monitor knowledge use. Collecting
data on knowledge use isare essential and providing the service
aligns with the project purpose (Bryant et al., 2019). It will help
stakeholders make some changes if needed to facilitate the
project.
The sixth phase isare to evaluate the outcomes.
It isare vital to assess the effects of the strategy
intervention to inform future decisions. Intervention evaluation
helps determine if any goals should beam addressed to enhance
the project outcomes (Zhao et al., 2021). The DNP student may
evaluate the results by interviewing patients and the patient’s
care team. Internal sources may also include weight changes, as
evident in the clinic’s data.

Phase seven of the KTA model isare to sustain knowledge.
There should beam strategies for supporting evidence-based
knowledge to enhance and impact the current practice.
Knowledge implementation isare more effective if it isare
maintained for a long time. To sustain long-term weight control,
nutrition knowledge, attitudes, and dietary self-regulation
areare significant predictors of overweight and obesity (Balani
et al., 2019).Methodology
Review Protocol
The search for appropriate literature waswas centered on key
terms, concepts, and phrases, including obesity care, physical
activity and obesity, lifestyle implications, and activity
trackers. The primary databases where the resources werewere
drawn areare Chamberlain Library, CINHAL, and PubMed.
Studies conducted for the preceding 4-5 years (between 2017 to
2022) werewere included in the search. During the initial
search, 20000 articles werewere found, and only 45 werewere
selected based on the relevance and availability of the entire
study online for further examination. The 45 studies werewere
then filtered down to 15 more appropriate studies to answer the
PICOT question: In overweight adult patients in a primary care
clinic, what are the impact of implementing the American Heart
Association Diet and Lifestyle recommendations, compared to
standard care, on body weight in 8-10 weeks?.
The search started by defining the key terms related to the
PICOT question: Obesity care; Obesity complications; Lifestyle
recommendations; Obesity management; Physical activity
intervention using Fitbit activity trackers and narrowing it
down to the focus theme of the integrative review: The AHA
lifestyle recommendations and obesity. After having searchable
questions, the keywords and phrases that can express the two
concepts werewere determined. A concept map waswas then
developed to guide the search process by showing the
relationship between the key terms or concepts in the PICOT
question. After defining the searchable question and having the

relevant keywords, phrases, and concepts, the databases with a
broad range of evidence werewere determined, and the search
process began.
The search strategy accounted for all possible search terms,
keywords, and key phrases that could help yield results that
answer the PICOT question. The search waswas done using
keywords, exact phrases, and adjacency which yielded more
relevant results. Article titles werewere also used to search for
known key papers used in developing the project plan. At the
end of the initial search, 2000 many results werewere produced,
and the next step waswas to make the search comprehensive.
Reference lists of retrieved articles were hand-searched. The
search was limited to published peer-reviewed studies in
English. The appropriate filters, relevance, and currency
werewere used to filter the yield and arrive at the 15 articles
used for the review. Comment by McGonigal, Shelly (AHN):
What were the appropriate filters? This section is good but
lacks detail into how you filtered/adjusted key terms to get to
15Inclusion/Exclusion Criteria past tense
The types of studies and levels of evidence played a significant
role in determining what should beam included in the
integrative reviewstudy. The integrative review project relied
on levels I, II, and III of evidence to get high-quality and
justifiable findings based on high-quality research designs. The
types of evidence included in the review can beam grouped into
the following: experimental studies, RCTs, Systematic Analyses
and Meta-analyses of RCTs, and observational studies. A total
of 15 eligible studies were included in the integrative review.
Of these, 1 was an experimental study, 1 was an observational
study, and the rest 13 were randomized controlled trials. The
study settings varied and included: North America, Vancouver,
Canada, western Europe, Oceania, India, Australia, Scotland,
and the Tyneside region of England. All 15 studies used adults
aged 18 and older as samples and were written in English.
Comment by McGonigal, Shelly (AHN): This section is

good - just need more detail What years did you
include/exclude; demographics? Full text? Journals? White
Papers? Etc. Comment by McGonigal, Shelly (AHN): This is
an integrative review - not a study - please adjust
These study designs yield objective, high-quality information
that can beam successfully implemented. Evidence from
opinions and single descriptive studies werewere excluded from
the study. Studies of lifestyle interventions to prevent obesity in
adults were eligible for inclusion. Studies of pharmacotherapy
were excluded. Studies that included less than 18 years old
participants were excluded.
The studies included in this review wereare those with
realistic, practical recommendations. The recommendations
must beam aligned with the investigated problem and whether
the interventions wascan be implemented successfully in terms
of dosage, method of implementation, and the time it takes to
implement the intervention. For example, it may beam
unrealistic to recommend interventions that take more than five
years to evaluate and determine outcomes. Studies whose
recommendations seemed unrealistic or required too much time
for implementation werewere excluded.
The last criteria werewere credibility, currency, and relevance.
The study included sources that have beenbeen published in
credible journals and credible authors. They must also beam
relevant because their findings directly relate to the project
problem. Lastly, the sources werewere analyzed in terms of
currency to ensure the data extracted areare current and can
beam used to address current problems. Sources whose
credibility waswas questioned, published more than five years
agoago (before 2017 to 2022), and do not directly
addressaddress the PICOT question werewere excluded.
Comment by McGonigal, Shelly (AHN): Need years...
Data Analysis
After defining the question and identifying studies that meet the
criteria for the integrative review, data werewere extracted by
reading through the studies and summarizing the relevant

findings using the John Hopkins Nursing evidence base practice
tool. While reading through the studies, it waswas essential to
identify any possible biases that would compromise the quality
of the study. During summarization, the meaning waswas
attached to the findings through critical interpretation, and the
summary findings werewere input into the John Hopkins
evidence table for easy analysis. Comment by McGonigal,
Shelly (AHN): Did you use a tool for the analysis of the
articles? John Hopkins Nursing evidence based practice tool?
Good work - just light on detail.
After all the data waswas extracted, a qualitative approach
waswas used to analyze the findings. The approach involves
collecting descriptive, non-numerical data to help understand
experiences, concepts, experiences, and opinions. The
qualitative approach waswas used to gather in-depth insights
into the problem and generate ideas to help address the PICOT
question. The choice of qualitative data analysis waswas
informed by its ability to define critical points from several
studies and summarize them into meaningful data. Qualitative
analysis also gives room for in-depth examination, a feature that
may not beam present in quantitative analysis (Agunis &
Solarino, 2019). Through qualitative data analysis, the review
yielded findings related to the effectiveness of AHA
recommendations, the use of technology, and factors that can
influence better intervention outcomes.
A thematic analysis approach waswas used to analyze the
data and generate results from themes relevant to the project.
The analysis waswas conducted in three main steps;
familiarization with data, identifying common themes across
several studies, grouping all the findings related to specific
themes, and putting down all the findings in a synthesis form.
The approach isare advantageous because it enables one to
understand the patterns in data and find relevant findings that
will address the research problem. It isare also a straightforward
approach that consumes less time.Results and Discussion
Characterization of the Body of Literature

The integrative review waswas based on high-quality resources,
credible research designs, appropriate participants, and realistic
and ethical recommendations. The evidence types included
experimental designs, RCTs, systematic reviews, and
observational studies. The sources werewere published in
credible sources, including the
American Association of Nurse Practitioners, the
American Psychological Association, the Journal of Digital
Health and Open Science, and the Journal of Public Health.
The literature sources werewere drawn from Chamberlain
Library, CINHAL, and PubMed. The three werewere chosen
because of their credibility, as most of the articles in these
databases areare authentic. After the initial search, about 2,000
articles surfaced, which called for further review to come up
with sources that addressed the PICOT question. Therefore, the
DNP student narrowed the search to key terms and concepts and
exact phrases so that the results werewere filtered to more
relevant ones. After using keywords and phrases, the search
waswas filtered to 45 papers only. Further, other mechanisms
such as type of research design, currency, and relevance to the
project werewere used to review, and in the end, 15 sources
werewere used for the review. The DNP student felt the 15
would better address and answer the PICOT question: In
overweight adult patients in a primary care clinic, what are the
impact of implementing the American Heart Association Diet
and Lifestyle recommendations, compared to standard care, on
body weight in 8-10 weeks?.
The Strengths of the resources werewere examined, and it
waswas found that the sources used for the integrative review
areare credible, authored by professionals, and published in
trusted and high-quality peer-reviewed journalsjournalsw such
as
ScienceDirect, The Journal of the American Association
of Nurse Practitioners, The Journal of the American

Psychological Association, The American Journal of preventive
medicine, The Journal of Medical Internet Research (JMIR) and
The BMC Biology and BMC Medicine, specialist Journals. They
provided comprehensive, precise, and reproducible data that
stated measurable outcomes. In all the sources, the observable
outcomes werewere evident. Comment by McGonigal, Shelly
(AHN): Which journals?
The integrative review relied on randomized controlled trial
(RCTs) that test the relationship between cause and effect. The
findings from the RCTs have minimal bias and help to establish
a direct outcome of the lifestyle interventions. RCTs also
administer interventions in a controlled way which enhances the
effectiveness of the research.
The integrative reviewstudies were based on reliable data
collection and analysis methodologies, contributing to the
research's overall quality. The studies werewere analyzed using
statistical methods or qualitatively and bore insightful results.
Strict eligibility criteria werewere used to ensure that the
sources used werewere credible and of high quality. Only
studies levels I, II, and III clasifiyed using the Johns Hopkins
Nursing Evidence- Based practice research Evidence Appraisal
tool werewere used, implying that the findings wereare credible.
The weaknesses of the resources werewere examined, and it
waswas found that one of the most common limitations of
studies isare the risk of subjective bias at different
stagesvarious stages of the research. The sources areare
evidence of subjective biases during study design, data
collection, and analysis. Some systematic errors may affect the
quality of the studies.
Most studies werewere conducted in specific populations,
making it challenging to generalize and apply the findings in a
different setting. It makes it challenging to establish the extent
to which the results can beam applied in a broader context. As a
global problem, obesity should beam approached from a broader
perspective. The results of a specific population in one part of a

country may not represent all the patients.
Detail are required – Check on page requirements – this section
appears to am short. More specifics…Findings Synthesis past
tense
The integrative review studies yi yielded significant evidence
that helped to answer the PICOT question and what can beam
incorporated in practice to enhance healthy living and boost the
quality of life. Researchers have identified lifestyle
interventions and practices that can beam implemented to
prevent and manage obesity. Research done by Balani et al.
(2019) points out that self-regulation isare the first step to
managing weight and living healthily. Self-regulation entails
consuming the right amount of food at the correct intervals to
avoid beingbeing overweight. Wadden et al. (2020) shared the
same sentiments and maintained that people who regulate the
amount of food intake arewere likely to be healthier and
prevented obesity and other diseases associated with lifestyle.
Such patients arewere less vulnerable to obesity, especially if
they arewere free from other linked factors, such as genetics.
Comment by McGonigal, Shelly (AHN): What were the
key themes from the articles - synthesize the findings
Researchers also emphasized that self-regulation of food intake
and physical activities enhancedfood intake self-regulation,
coupled with physical activities, is likely to enhance the quality
of life. In their study, Wadden et al. (2020) also mentioned that
patients engageding in physical activities, such as exercising,
recordedleads to long-term weight loss, which makeing people
healthier and less obese. As people exercised, they burned
calories in the body, which resulteds in weight loss. The
findings are emphasized by Swift (2018), who revealeds that
exercisingexercising, and training hadve solid clinical
significance and reduceds obesity. For people who arweree
already battling medical issues, exercises and lifestyle
changestraining exercises helped manage the issue. However,
Beauchamp (2018) insisteds that patients should bebe monitored

and supported to enhanced outcomes. In his study, Beauchamp
reveals that patients who arewere supported and monitored
arewere more likely to adhered to healthy behavior than those
who arewere not monitored or supported. Monitoring also helps
to identify any issues that may hinder effectiveness and address
them as soon as possible.
Evidence from the sources also shows that lifestyle
interventions areare significant in weight management, and
implementing these interventions contributes to healthy living
in the community. Jerome (2019) conducted a study that
revealed that lifestyle modifications areare clinically significant
and reduce incidences of obesity when implemented
appropriately. Balani et al. (2019) conducted an online survey
that revealed that people who regulate food intake in their
bodies areare in a better place to attain and maintain a clinically
appropriate weight. In a different study, Bergum (2021)
mentions that lifestyle interventions reduce blood pressure and
control weight gain. Patients who can control weight
automatically become less vulnerable to obesity. However,
these researchers also raise concerns about the effectiveness of
lifestyle interventions on obesity, saying that they may not
directly affect the amount of cholesterol in the body. The
concerns areare built on the basis that the effectiveness of a
lifestyle intervention depends on many other internal and
external factors.
Jiang (2022) also found out that patients who receive lifestyle
interventions reduced the risk of obesity and enhanced their
quality of life. While Wadden et al. (2020) acknowledge the
role of physical training in weight management and long-term
weight loss, the researchers found that patients require face-to-
face sessions where they areare counseled and motivated to
remain on track. The researchers mention that online monitoring
isis less effective because it encourages non-adherence, and
patients may not report the actual progress. When patients meet
in a physical setting, they exchange ideas and progress,
challenging each other to stay on track. On their part, Swift et

al. (2018) challenge patients to incorporate diet and physical
activities together, saying they areare more effective when
implemented together compared to when either of them isis
implemented. Swift and colleagues also argue that 150 minutes
and 75 minutes for moderate and vigorous exercise areare
insufficient to make a clinical difference.
Lean et al. (2018) also conducted a study that revealed that
dieting and physical activities significantly prevent and manage
type 2 diabetes. The researchers conducted a Randomized
Control Trial (RCT) where more than half of the participants
recorded positive results after 12 months of an intensive weight
management program that included physical activity and
dieting. After the program, these patients attained remission of
type 2 diabetes and werewere freed from antidiabetic drugs.
Therefore, the researchers concluded that lifestyle health
management effectively prevents and manages lifestyle
diseases. In a randomized control trial conducted by Groessl
(2019), physical activity intervention addresses long-term
negative implications associated with obesity, such as reduced
mobility; obese patients who engage in physical activity areare
less likely to experience mobility issues compared to those who
do not. The researcher mentions that while patients may have
trouble treating obesity thoroughly, they can manage obesity-
related complications through healthy lifestyles.
Apart from dieting and physical activities, researchers have
acknowledged the significance of technology in using the AHA
recommendations to manage weight and attain a high-quality
life. As the healthcare system embraces technology, researchers
also continue to assess how patients can benefit from the latest
technological tools and applications. One of the technological
tools isis wearable trackers that have positive and negative
effects on implementing AHA recommendations. According to
Brickwood et al. (2019), patients who use wearable trackers
when exercising areare likely to increase their step count over
time as they get motivated. However, according to the study, the
motivation will depend on other internal and external factors,

such as tolerance, state of mind, and weather conditions. For
example, patients with a high tolerance areare more prone to
continue working than those with a low tolerance. Similarly,
poor weather conditions, like a rainy evening, may discourage a
patient from jogging. In the same study, the researchers
revealed that wearable trackers increase monitoring, enhancing
patients’ ability to monitor their progress.
Following et al. (2019) conducted a qualitative study that
identified trackers as enhancers and distracters in patients’
participation. According to the researchers, the trackers act as
either success or failure proof which may motivate or
demotivate patients. When a tracker records positive progress,
patients will likely bebe motivated and continue with the
interventions. Similarly, a systematic review conducted by Gal
(2018) shows that wearable trackers and phone applications
areare practical tools that encourage patients to continue
exercising and training through successful monitoring. On the
contrary, patients may stop exercising if the tracker records
zero or negative progress. The researchers recommended
individualized trackers that meet clients’ needs to avoid
discouragement. Gal et al. (2019) revealed similar results: a
tracker can promote or inhibit physical activities among
patients. Gal and her colleagues recommend that patients have
other forms of support and motivation to maintain a healthy
lifestyle.
The two preceding studies acknowledged that trackers cancould
promote engagement in physical activities, but they depend on
other external factors. Therefore, it was is crucial to check on
all factors before ascertaining the impact of the trackers. For
example, clients who areare less willing to use the tracker may
yield minimum benefits even when they use them. The aspect of
willingness and acceptability has beenbeen researched by
Vandelanotte et al. (2020), who reveal that clients’ acceptability
and willingness to track their progress enhances or reduces
intervention outcomes. More willing and accepting users areare
more likely to benefit from the trackers than those who areare

unwilling. The authors, therefore, challenged patients to
embrace embrace trackers and use them appropriately to bebe a
source of motivation. On his part, Hu (2021) maintains that
connectivity also determines the outcomes of the interventions
concerning patients’ ability to stay in touch with mentors who
keep engaging them and updating their progress. However, he
maintains that self-tracking apps areare easy to use, and if
patients areare willing, they will register positive outcomes.
Researchers went further to determine the internal and external
factors that may enhance the outcomes of lifestyle intervention.
These factors areare likely to make a positive difference when
incorporated into practice. In research conducted by Balani et
al. (2019), patients' attitudes and nutrition knowledge affect
their ability and willingness to stay committed to intervention
programs. Patients knowledgeable about nutrition and have
positive attitudes toward weight management arewere likely to
bebe more committed to the programs and achieve positive
results. The study authors, therefore, challenge healthcare
institutions to invest in patients’ knowledge and attitudes which
they believe will enhance outcomes. In another study, Ma
(2017) attributed the lack of positive outcomes to a lack of or
poor assessment, which demotivates patients and makes them
return to their unhealthy lifestyles. The researcher argues that
frequent evaluation of the interventions will help keep patients
on track and enhance outcomes and determine any gaps that can
bebe fixed to enhance outcomes.Conclusions and Further
Recommendations
Implications for Nursing Practice past tense
Primary clinics should incorporate the AHA recommendations
as part of the treatment plan protocols to enhance patient
outcomes. Healthcare professionals should educate patients on
the importance of healthy living and provide them with the
necessary support, such as remote monitoring, to ensure they
can sustain positive outcomes. There should bebe efforts that
enhance adherence, such as personal sessions to encourage the

patients to eat appropriately and engage in physical activities to
attain and maintain an appropriate weight. By doing this,
patients' overall quality of health will improve, and they will
incur fewer costs in treating and managing diabetes.
In nursing care, there should be be efforts to address obesity by
incorporating diet and healthy lifestyle recommendations, such
as offering patients the right nutritional foods with the right
efforts to address obesity by incorporating diet and healthy
lifestyle recommendations, such as offering patients the right
nutritional foods with the right amounts of calories needed.
There should bebe time for physical activities, such as evening
walks, as patients can improve their general quality of life and
treatment outcomes. Nursing care today should be be done
holistically, meeting patients' physical, mental, nutritional, and
emotional needs to avoid over-relying on medications alone,
which may not register positive outcomes in some cases done
holistically, meeting patients' physical, mental, nutritional, and
emotional needs to avoid over-relying on medications alone
which, in some cases, may not register positive outcomes. These
efforts will result in reduced hospital stays, enhanced patient
outcomes, and better job satisfaction among healthcare
professionals.
At the organizational level, healthcare institutions should
embrace lifestyle interventions and develop treatment plans
incorporating lifestyle aspects to cut costs. Remote monitoring
of patients about adhering to lifestyle intervention should also
be be implemented to reduce admission rates and hospital
check-ins, reducing implemented to reduce admission rates and
hospital check-ins, as this will reduce daily hospital costs.
Therefore, facilities should embrace technology and utilize
modern tools to improve telehealth and reduce costs while
maximizing outcomes.
Check the requirements for this section – micro/meso
impact?Conclusions and Contributions to the Professions of
Nursing past tense

Obesity isis a significant individual, community, national, and
global healthcare problem. According to research, lifestyle
interventions effectively manage appropriate body weight and
prevent obesity (Wadden et al., 2020). People who implement
dieting and physical exercises areare more likely to achieve
long-term weight loss than those who do not (Swift et al.,
2018). The integrative review found that incorporating regular
physical activity and a healthy diet help to diminish multiple
medical issues connected with obesity (Bray & Ryan, 2020),
reducing the expenses associated with obesity treatment for
organizations, which improves clinical results and nursing care.
This systematic review supported the effectiveness of the AHA
Diet and Lifestyle recommendations to prevent and reduce
obesity, and clinical use isis recommended as an innovative
solution. The lifestyle recommendations areare practical, as
Bergum et al. (2018) revealed that patients who incorporate
healthy eating and exercise register low body weight. However,
the interventions areare more effective if followed by face-to-
face counseling to enhance outcomes (Wadden et al., 2020).
Interventions areare also more effective than dieting or physical
exercises alone (Swift al., 2018). Swift isis further concerned
that 150 minutes for moderate exercise and 75 minutes for
vigorous areare inadequate to make a clinical difference.
Researchers further acknowledged technology's role in
implementing AHA diet and lifestyle recommendations. Clients
who use wearable trackers become more motivated and register
more steps in physical exercise (Brickwood et al., 2019).
Similarly, Gal et al. (2019) and Vandalanotte et al. (2020)
reveal that wearable trackers enhance engagement in physical
activity. However, the researchers further show that wearable
trackers areare more effective if patients areare willing to use
them and if they can access customized trackers that meet their
needs.Recommendations Do not bullet – it must be in
paragraph form.
Because obesity isis a prevalent disease, primary care clinics

must devise a plan to address this chronic illness.
Healthcare professionals and other stakeholders should educate
patients on the importance of lifestyle interventions to enhance
their acceptability of dieting and physical activity.
Nurses should incorporate lifestyle interventions in their daily
care plans to enhance treatment outcomes.
Patients should also embrace healthy living as a prevention and
management mechanism for obesity and other lifestyle-related
diseases. They should bebe committed to the intervention to
enhance intervention outcomes.
Patients should embrace wearable trackers and mobile
applications to help them monitor their physical activity
progress and use them as a motivation to adhere to healthy
living.
Future researchers should consider examining the effectiveness
of the knowledge-to-action implementation model in
implementing AHA recommendations for obesity prevention and
management. Examining this model will help establish the most
appropriate population for this implementation approach.
Researchers should also address the limitations of the research
designs in this review to enhance the quality of the data
extracted. First, there isis a need to research different
participants and geographical areas to enhance the
generalizability of the research findings. Future researchers
should also minimize subjective bias as much as possible to
enhance objectivity, enhancing the research quality.
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