The primary objective of this study is to assess the possibility of implementing weight loss strategies in the elderly population. The study targets the obese older people and the feasibility as well as the acceptability of various intervention for weight reduction. This study will also inform on the design that is more convenient in conducting randomized control trials. If the results obtained using the current methods will be statistically relevant, the study will recommend the application of the approaches proposed on a larger population scale. Future implementation of the methods, materials, and interventions will depend on the outcome measure indicators (Ward et al., 2018).
The researchers were interested in the feasibility and applicability of Older adults Wight Loss (OWL) interventions and the possibility of scaling up the interventions for future application in population-based studies. The broader purpose of the study was to elaborate on the design of case-control randomized studies with participants drawn from multiple centers to describe the applicability of the methods in large scale. Some of the proposed methods include recruitment, intervention delivery, follow-up and retention, and randomization. In line with the methods proposed for the study, various research questions will be addressed in the study. The questions include (1) Is the OWL intervention feasible and acceptable to participants? (2) What outcome measure adequate to participants? (3) What magnitude of weight loss and change in outcome measures might be expected from this intervention (to inform future sample size calculations) (4) Are the recruitment and retentions procedures feasible and acceptable? and (Organization, 2008). What are the training and staffing needs to implement this intervention?
The design assesses the applicability of the OWL approach and provides additional information on the choice of outcome estimation strategies. The study proposes to implement the OWL strategy in a community setting in a self-managed approach. The study will be conducted in the northeast parts of Scotland (Boyers et al., 2015).
Participant recruitment was performed for three months. In the recruitment strategy, gender balance will be observed by including both male and female participants from North East Scotland. One of the requirements for one to be included in the study is that they must be obese at the time of recruitment (BMI of 30kg/M2 and above) and are aged 65 and over. Further, only those who confirmed that they would be residing in the community for the entire period of the study were included (Read et al., 2016). The participants who reported health conditions were not excluded from since the participant age was the main criteria for recruitment (Vincent, Vincent, and Lamb, 2010). The researchers target to use poster and GP adverts to reach out to community members to enroll in the study. The researchers also plan to enhance the scope of the participants through media adverts (Villareal et al., 2011). Researchers did not set a limit for sample size. Instead, they decided that the participants who will have been recruited in the three months will form the official sample size for the study. Moreover, a maximum of 4 groups with at least 4 participants each was the target of the researchers in the 3 months of participant enrollment.
The study methodology and design constitutes the middle stage of the three-part design randomized control trial (RCT). The first section of the study formed the pilot study through a systematic review which pointed out nine trials between the year 1966 and 2008. The trial’s target were interventions for weight reduction among the elderly with a lower age limit of 60 years other three trials included participants above 65 years (LaRose et al., 2013).
The researchers will consider the interpersonal skills of the professionals involved in the delivery of the interventions and training received as critical indicators of quality delivery of the responses to participants. Thus, the weight management experts hired will have to demonstrate experience in weight loss support and working with older adults (Leon-Munoz et al., 2005).
The researchers decided to perform the intervention for 9 months including weekly group meetings. The group meetings will last for a one-hour session. However, the researchers recommend frequent meetings to accelerate the rate at which the study objectives will be fulfilled. Due to resource implications, the researchers settled on adopting meeting sessions similar to those in NHS interventions. One approach used by the researchers to cut down on the cost of the response was to replace the high-cost resources with low-cost information resources such as cards and newsletters (Rejeski et al., 2011).
Methods: The pre-intervention phase
This stage of intervention implementation comprises of the activities which will be performed before the intervention implementation. The researcher proposes to develop the pertinent materials required for the full application of the intervention. Here the researchers will recruit multidisciplinary experts drawn from fields such as nutrition, psychology, and geriatrician experienced in older adults’ weight loss; the panel will be responsible for pulling together all the necessary materials for the intervention. The researchers plan to put in place a robust communication system for the group to ensure that there is effective coordination among the panel members (Gladstein, 1984). To achieve high-quality material for the intervention, the panel will work in partnership with other experts from the University of Aberdeen.
The study intervention includes attaining at least 500 calorie reduction in the diet through approaches such as decreased intake of high-calorie foods and self-chosen physical activities. The interventions proposed in this study will help the elderly to effectively body fat content through a healthy balanced diet and active lifestyle. The selected intervention will be performed in various sessions where each session will be multifaceted targeting to achieve both a healthy eating and an active lifestyle. Evidence-based behavioral change is part of the approach that will be applied to measure the outcomes (Messier et al., 2005). In terms of intervention delivery, small groups of the participants will be constituted, and a different strategy used to impart skills for diet change and improvement in physical activities. For instance, group support and peer feedback will be applied to educate group members on the best diet practices and increased physical activities. To ensure maximum skill gain, professionals such as weight management experts (WME) will be involved in educating the participants on the best strategies for weight management. The researchers will use group support and peer feedback to enhance delivery. Weekly OWL cards and newsletters, as well as the aid of the WME, will be used to support the groups. These approaches are particularly useful as they are cost not only practical but also effective in information delivery (Ding et al., 2008).
To ensure optimal initiation of the proposed change, the researchers proposed to break down the intervention into three stages each being 12 weeks. The first stage was the change initiation stage in which a WME assigned to a group will be required to educate the participants on the OWL interventions and help tailor the response to both the group and individual level. This intervention is critical as it ensures that the needs of both the group and the individual participants are met. To facilitate this objective, the WME will organize meetings with the groups on fortnight intervals. In addition, the WME will be able to reach the group members through telephone calls and emails. Cards and newsletters will also be used as buck up strategies to ensure that the group members have access to as much information as possible.
The second stage is group self-management which proposes that the change process will be initiated through external support first then to a self-run group. During this face, the researchers propose to reduce the face-to-face meetings to only once a month backed up by monthly email and phone communication between the WME and the group members (Crowston et al., 2007). This stage is particularly important for this research as it will enable the group members to start implementing the recommendations of the WME with limited help from the trainers. Afterward, the group members will be in a position to self-manage the entire process of change implementation.
The third stage of the intervention implementation is the maintenance of the group and group sustainability. This process marks the transition of the group from a fully supported group to a self-managed group. One of the strategies in this stage is the withdrawal of the WME support to enable the groups to remain self-sustaining. This method is essential to the development of skills at both the group level and individual level.
Optimization of the intervention
The researchers proposed to increase the effectiveness of the intervention through two approaches; first, the researchers sought to expand the research base by identifying the potential mechanisms through which obesity can be reduced in older adults. The second approach is to enhance the understanding of the mechanism of action of the intervention including the sources of variation such as participant characteristics and setting of the research (McConnell et al., 2013). To achieve this objective, the researchers intend to explore delivery and acceptability of the intervention. The researches also propose to apply process measures as an outcome as well as collecting weight loss data to help guide the future application of the response using an RCT approach. The evaluation of this strategy shows that the researchers applied a robust method for evaluating the potential for the next application of the intervention. By employing process measures as well as the outcome measures allows the researchers to collect enough data that can be analyzed statistically and applied in the prediction of the future applicability of the intervention over a larger population. Therefore, the researchers selected effective methods in the research.
The researchers propose to use the outcomes of the current study to guide the choice of outcome measure to include in the randomized multi-center controlled trials. Specifically, the researchers are proposing to examine the acceptability of the frequently applied measures and the application of the generated data in outcome measures. Data such as the food eaten, in food diary will be encouraged in the research. Such data recording intends to help self-monitoring as well as assess process measures of right behavior change. According to (Ramage et al., 2013) participants may benefit from the process of weight evaluation trials. For instance, completing study materials may enhance participant motivation, understanding, and awareness of important determinants of weight loss. Thus the researchers have complemented the outcome measures into the weight loss intervention. Some of the outcome measures are in the form of self-test questions and self-monitoring tools. The researchers have applied an integrated method for data collection and the intervention which appears to be highly effective as it will enable them to collect the outcome measures while lowering the impact of the trial on the intervention (Tsigos et al., 2008).
The researchers have allocated a considerable amount of time in the Gantt chart reflecting the value they have placed on the ethical aspect of the research. Thus the researchers have recognized the need for seeking research approval before the research commences. Research principles have weighty implications on the current research as it involves direct recruiting of human subjects to participate in the study (Rossi et al., 2009). Some of the research principles that must be considered include autonomy, beneficence, respect for community and justice (Edwards et al., 2004). The study subjects are older adults who are more vulnerable to abuse underscoring the need to take ethical issues arising from the research more seriously.
The study significance
The proposed study is significant and could significantly add to the existing knowledge in the field of weight loss which has remained scarce. If the study will be successful, it will provide a robust approach for older adults’ weight loss and promote the health of this category of people. Improved quality of life is one of the outcomes of the intervention if successfully implemented; therefore, it is evident the current research will significantly contribute to healthy living and care for the older adults who are obese (Ross et al., 1999)
The accuracy of the proposed methods
The researchers have chosen to apply materials which have been used before in other studies and proven to be effective. Established tools which have been widely applied have also been selected for this study. For instance, the intervention is based on the Scottish Intercollegiate Guidelines Network. The guidelines have been revised and universally accepted. One of the recommendations of the guidelines is the behavioral changes to achieve a healthy life along with keeping a balanced diet and increasing physical activities that help to keep weight under check. This strategy was implemented in the OWL through the use of cards and frequent group meetings.
A dietary recall has been proposed as one of the methods which will be used to ensure optimal follow-ups. This method is particularly important for this research as the participants are elderly and may require frequent follow-ups to reduce the incidences of loss to follow up (Di Carlo et al., 2002).
The researchers’ decision to include anthropometric measures is also key as it helps to ensure holistic monitoring of the participants’ health indicators. However, the researchers did not detail this approach in the proposal. Another drawback of the proposal is that anthropometric measures may not be effective determinants of health in older adults as the indicators may be affected by the aging process and not necessarily diet and lifestyle (Perissinotto et al., 2002).
Section 5 of the proposal details the responsibility of some of the research team members. The vital role of the WME has been detailed and how their input in the groups will reduce gradually as the team member’s participation gradually increases to take over the part of the WME. The ability of the group members to produce similar results as those provided by the WME is an indicator of reproducibility of the results and expected outcomes. However, one flaw that has been identified in the research proposal is that the researchers did not consider to come up with a preset sample size instead they estimated the number of participants recruited based on the time available for participant recruitment. This approach may significantly hinder the reproducibility of the study parameters.
The researchers designed the study to be an RCT. The RCT studies are usually cost intensive, time intensive and more often than not, the study does not answer all the research questions. The mentioned characteristics of the RCT studies limit the scope of the survey; hence the study has a small range. The narrow field of the study defines the researchers in many ways, including the recruitment of a small sample size due to financial constraints. On the other hand, the strengths of the RCT approach include the ease with which the benefits and limitations of the intervention can be pointed out hence allowing the researchers to seek possible solutions to the shortcomings of the response through adjusting various aspects of the research.
Long term stability
The researchers have provided a timeline of the research which stretches through a period of 18 months. Further, the researchers have outlined in tables 9 months follow up period. The follow-up period will consist of sections lasting for one hour fortnightly. Thus the researchers have provided a clear project timeline and justified the long-time stability of the research.
The research strengths and weaknesses
First, a research proposal must contain specific primary components that are almost always universally included in the proposal document. For instance, proposals must contain a title, Abstract, table of content, list of figures and stables as well as the introduction, literature review, methods, and references sections. For this proposal, the first and most important section; the title is not indicated. The researchers need to indicate the proposal title to guide the reader and help the reader understand what the research is about at the first instance.
Moreover, the researchers did not even provide a summary of the important sections of the proposal in the form of an abstract. It is, therefore, not easy for the reader to understand the scope of the proposal without having to read through the entire document. The researchers should consider improving the proposal by following the guidelines for proposal formatting which will enable the researchers to incorporate all the necessary sections.
In the current proposal, the aims section comes after the explanation of a pilot study which should appear under the methodology section. Thus, the aims of the proposal have been placed in the wrong part of the proposal. A standard format of proposal writing recommends that the aims should be included under the introduction just after the background information. This assists the reader to understand the aims of the study before delving into the methods and pilot study as it is the case in the current proposal.
The introduction and the literature review have not been segregated in the current proposal. The researcher did a good job in introducing the case of obesity in Scotland by providing valid evidence of the prevalence while citing reputable sources. This is commendable. However, the researchers were to separate the background information from the literature review to allow the reader to understand the research in a systematic format.
The explanation of the OWL was not sufficient enough to enable a reader from a different field to understand the OWL intervention. Despite the experienced readers from the area of nutrition being able to read the proposal and figure out what the researchers are explaining it is essential for the researchers to build the concept behind the OWL strategy and provide credible sources formatted in the recommended reference style.
The plan and methodology for the OWL intervention have been explained clearly by breaking it down into various stages for ease of understanding. The proposal described the inclusion criteria for both age 60 and above 65 which is in line with the different age groups in the UK as reiterated by the Office of National Statistics. The segregation of the age limits for inclusion into the research strengthens the choice for the location for the study.
Performing a pilot study as through systematic literature review is a strength of the proposal as it helps the reader to understand the perspective of the study in the context of available data in the literature and helps the researchers to determine the kind of results expected at the end of the study.
Various studies support group intervention for weight loss. For instance, (Plotnikoff et al., 2015) demonstrated the lack of studies which compares the effectiveness of the intervention between male and female participants. The researchers can, therefore, consider including the aspect of gender comparison of the efficacy of the intervention to find out variations in the effectiveness of the intervention in both male and females.
The researchers mention that they will record weight loss data for application in RCT in the future. Furthermore, the researchers mention that they will apply appropriate descriptive statistics, but there is no further explanation of the statistics. Finally, the proposal contains a few grammar errors and typos. The proposal needs to be improved in terms of the overall layout and formatting. There is no conclusion made at the end of the proposal, and the researchers did not provide a budget for the research which is a critical component of a proposal.
Boyers, D. et al. (2015) ‘A systematic review of the cost-effectiveness of non-surgical obesity interventions in men’, Obesity research & clinical practice. Elsevier, 9(4), pp. 310–327.
Di Carlo, A. et al. (2002) ‘Incidence of dementia, Alzheimer’s disease, and vascular dementia in Italy. The ILSA Study’, Journal of the American Geriatrics Society. Wiley Online Library, 50(1), pp. 41–48.
Crowston, K. et al. (2007) ‘The role of face-to-face meetings in technology-supported self-organizing distributed teams,’ IEEE Transactions on professional communication. IEEE, 50(3), pp. 185–203.
Ding, C. et al. (2008) ‘Association between leptin, body composition, sex and knee cartilage morphology in older adults: the Tasmanian older adult cohort (TASOAC) study’, Annals of the rheumatic diseases. BMJ Publishing Group Ltd, 67(9), pp. 1256–1261.
Edwards, A. et al. (2004) ‘Patient-based outcome results from a randomized cluster trial of shared decision making skill development and use of risk communication aids in general practice,’ Family practice. Oxford University Press, 21(4), pp. 347–354.
Gladstein, D. L. (1984) ‘Groups in context: A model of task group effectiveness,’ Administrative science quarterly. JSTOR, pp. 499–517.
LaRose, J. G. et al. (2013) ‘Differences in motivations and weight loss behaviors in young adults and older adults in the National Weight Control Registry,’ Obesity. Wiley Online Library, 21(3), pp. 449–453.
Leon-Munoz, L. M. et al. (2005) ‘Changes in body weight and health-related quality-of-life in the older adult population’, International journal of obesity. Nature Publishing Group, 29(11), p. 1385.
McConnell, T. J. et al. (2013) ‘Virtual professional learning communities: Teachers’ perceptions of virtual versus face-to-face professional development,’ Journal of Science Education and Technology. Springer, 22(3), pp. 267–277.
Messier, S. P. et al. (2005) ‘Weight loss reduces knee‐joint loads in overweight and obese older adults with knee osteoarthritis,’ Arthritis & Rheumatism. Wiley Online Library, 52(7), pp. 2026–2032.
The organization, W. H. (2008) ‘Projections of mortality and burden of disease, 2004–2030′, Geneva, Switzerland.
Perissinotto, E. et al. (2002) ‘Anthropometric measurements in the elderly: age and gender differences,’ British Journal of nutrition. Cambridge University Press, 87(2), pp. 177–186.
Plotnikoff, R. C. et al. (2015) ‘Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis,’ International Journal of Behavioral Nutrition and Physical Activity. BioMed Central, 12(1), p. 45.
Ramage, S. et al. (2013) ‘Healthy strategies for successful weight loss and weight maintenance: a systematic review,’ Applied Physiology, Nutrition, and Metabolism. NRC Research Press, 39(1), pp. 1–20.
Read, S. H. et al. (2016) ‘Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013’, Diabetologia. Springer, 59(10), pp. 2106–2113.
Rejeski, W. J. et al. (2011) ‘Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health,’ Archives of internal medicine. American Medical Association, 171(10), pp. 880–886.
Ross, S. et al. (1999) ‘Barriers to participation in randomized controlled trials: a systematic review,’ Journal of clinical epidemiology. Elsevier, 52(12), pp. 1143–1156.
Rossi, S. et al. (2009) ‘Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research,’ Clinical neurophysiology. Elsevier, 120(12), pp. 2008–2039.
Tsigos, C. et al. (2008) ‘Management of obesity in adults: European clinical practice guidelines,’ Obesity facts. Karger Publishers, 1(2), pp. 106–116.
Villareal, D. T. et al. (2011) ‘Weight loss, exercise, or both and physical function in obese older adults,’ New England Journal of Medicine. Mass Medical Soc, 364(13), pp. 1218–1229.
Vincent, H. K., Vincent, K. R. and Lamb, K. M. (2010) ‘Obesity and mobility disability in the older adult,’ Obesity reviews. Wiley Online Library, 11(8), pp. 568–579.
Ward, J. et al. (2018) ‘PILOT STUDY SURVEY ATTRIBUTES OF CHIROPRACTIC PATIENTS OVER 55 YEARS OF AGE.’, Chiropractic Journal of Australia, 46(1).