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DNP 8114 Module 4 Assignment Investigating a Critical Practice Question Through a Literature Review

DNP 8114 Investigating a Critical Practice Question Through a Literature Review

This week you will begin your Module 4 Assignment, which is intended to inform and support your planning for your DNP Project in your program of study. This Assignment has two parts: a literature review in the Walden Library of research to address the critical practice question that you framed in Week 7, and a critical assessment of your search outcomes in which you synthesize the evidence. Both Parts 1 and 2 will be due by Day 7 of Week 10. Plan your time accordingly.

Posttraumatic stress disorder is a major public health concern. Furthermore, the condition has been recently implicated in obesity and other metabolic dysfunctions. The increasing incidences of obesity among veterans with PSTD continue to pose a tremendous threat to the realization of goals in the Healthy People Act. Currently, it is estimated that about a third of the U.S population present with obesity and PSTD has been proven to be a predictor of obesity. The study conducted by Kubzansky et al. (2014) focused on the prevalence of PSTD and obesity among the veterans in Afghanistan. Based on the study, it was apparent that the other complications associated with PSTD include high blood pressure and another metabolic syndrome. Presence of obesity among the PTSD patients leads to poor prognosis and increases the health burdens as well as medication costs.


This section analyzes the existing studies conducted to explore the association between obesity and PSTD and how the co-morbidity affects the treatment outcomes among the veterans with PSTD. The review will focus on the studies published below five years ago. Based on the analysis, a deeper understanding of the relevance of the current study will be established. Furthermore, the existing gaps in the treatment and management of PSTD among the veterans will be explored. The articles were obtained from various scientific journals including PubMed, Sage, Google Scholars, and NCBI among others. The key terms used in the article search included PSTD, obesity and weight gain. Furthermore, a critical appraisal was conducted among the 20 selected articles. Finally, a total of seven articles that met the appraisal requirement were used in the literature review.

Synthesis of Literature

Part A: Main Components of Each Article

According to Masodkar, Johnson and Peterson (2016), there are no therapies for treating PSTD-associated obesity and this means that the realization of effective treatment and recovery of the veterans with PSTD is limited. Understanding the mechanisms involved in the development of obesity among PSTD patients is important in guiding the development of effective treatment strategies. The article is limited to the inefficiencies in the management of PSTD; though, does not provide a clear outline on how the issue can be addressed. However, based on the article, the burden of the problem in the PICOT statement can be explored.

Similarly, Scherrer et al. (2018) report that the possible modulators of the interaction between obesity and PSTD include alterations in the control of appetite hormone, altered neural and cognitive changes and disruptions in the inflammatory markers. The research findings in the study are consistent with the findings in the studies conducted by Masodkar, Johnson and Peterson (2016), which show that PSTD increases the risks of development of the metabolic syndrome and obesity. Developing programs that address the weight gain among the PSTD patients would thus serve as an important part and intervention in the management of PSTD among the veterans. On the other hand, the sample population recruited in this study was limited and thus unreliable. The article will be used in understanding the role of weight management in PSTD treatment as outlined in the PICOT question.

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According to Dorflinger, Ruser and Masheb (2017), PSTD results from a traumatic experience and results in chronic stress conditions which may promote weight gain. Furthermore, the study indicated that the prevalence of PSTD tends to be high among veteran women compared to their male counterparts. In as much as various approaches are used in the management of PSTD among the veterans, there is a great necessity to improve the treatment process to facilitate quick recovery. The proposed measure, in this case, aims at expediting the recovery process among the veterans with PSTD and eventually reducing the time taken for them to fully normalize and re-integrate to their work. Various study findings show that there is a strong correlation between PSTD and development of obesity among the veterans. The veteran populations are an important target group because they are vulnerable to PSTD due to traumatic and stressful experiences they undergo in the course of work. An association between PSTD and weight gain among the veterans is an important topic worth exploring since it helps in guiding the process of designing treatment measures and management of veterans with PSTD. However, a large sample population should be recruited in the current study because the existing studies are vulnerable to bias due to limited sample population.

DNP 8114 Investigating a Critical Practice Question Through a Literature Review

Batch et al. (2017) explored the factors contributing to weight changes among the veterans. A total 62,822 study participants were recruited and the intervention developed was the Motivating Overweight/Obese Veteran Everywhere (MOVE) program. The findings from the study indicated that the effectiveness of such programs in the management of PSTD differed by gender with women reporting lower symptoms of PSTD compared to the males. By average, the weight loss was 5% of the total weight and this provides vital data for the PICOT analysis. However, the study failed to outline the criteria used in diagnosing PSTD despite the sample population being sufficient.

Furthermore, Hoerster, et al. (2015) employed quantitative research in exploring the risk factors of obesity among the veterans in the US and Iraq presenting with PSTD. Data used in the study were collected from the VA Puget Sound Healthcare System and the recruitment of the sample used was based on the PSTD checklist. The study reported that 16.3% of the patients were positively diagnosed with depression and out of this, 37.8% tested positive of PSTD with 8.4 having binge eating disorders (Hoerster, et al., 2015). Based on the research findings, it was concluded that PSTD and depression and strongly associated with a binge. Addressing the issue of obesity among patients with PSTD would result in improved treatment outcomes for the targeted population.

Part B: Compare and Contrast the Articles

The various studies explored in this review analyze the role of PSTD in obesity development; though, they fail to respond completely to the PICOT question. According to the study conducted by Klingaman et al. (2016) and Klingaman et al. (2016), it was evident that the Veterans with PSTD significantly benefit from the weight reduction programs compared to those who do not present with PSTD symptoms. The findings in these studies are similar to what was reported by Masodkar, Johnson and Peterson (2016). However, there is need to explore further the need to integrate a comprehensive intervention aiming at promoting weight reduction in the course of treating veterans with PSTD. Evidence-based care approaches are developed to promote the patient’s wellbeing and this becomes more effective when patient-centered approaches are engaged. Based on the review findings, introducing the weight reduction programs can significantly reduce the PSTD symptoms among the veteran especially when they have both obesity and PSTD (Klingaman et al., 2016). The findings from these studies provide preliminary backgrounds for addressing the issue of obesity and PSTD among the veterans. The impacts of PSTD are severe in case they are not managed in time. Engaging a comprehensive treatment framework that incorporates both the pharmacotherapy and weight reduction programs are essential and these would help reduce the gaps existing in the treatment process and management of veterans with PSTD.

Areas of Further Studies

Furthermore, Kubzansky, Bordelois, Jun, Roberts, Cerda, Bluestone and Koenen (2014) conducted a study to analyze the role of obesity in the treatment outcomes of the patients with PSTD. The study involved a prospective design where patients initiated on the PSTD treatment in 1989 were followed up until 2005. The symptoms of PSTD were measured and recorded accordingly. Weight gain was determined using the body mass index which was calculated as weight in kilograms. The study findings indicated that obesity among the PSTD resulted in poor treatment outcomes. Therefore, clinicians should be keen to address the weight issues among PSTD patients. Similar findings were obtained by Masodkar, Johnson and Peterson (2016) who reviewed the role of the correlation between obesity and PSTD and how the co-morbidity affects the effectiveness of treatment interventions developed for PSTD. The current study focuses on exploring the effectiveness of the weight reduction programs as part of the treatment and management interventions for PSTD disorder. There is sufficient evidence from the existing pieces of literature that integration of the weight management programs in the treatment of PSTD results in good prognosis; however, no practical demonstration has been done to confirm this.  Considering that soldiers are at high risk of developing complications associated with obesity; developing effective measures to address all their health needs is critical and this will result in enhanced re-integration into the society. Thus, a need exists to examine the nature of these interventions and how they can be deployed to help the veteran population, particularly those with PTSD symptomatology.





Batch, B. C., Goldstein, K., Yancy Jr, W. S., Sanders, L. L., Danus, S., Grambow, S. C., &           Bosworth, H. B. (2017). Outcome by Gender in the Veterans Health Administration  Motivating Overweight/Obese Veterans Everywhere Weight Management. Journal of Women’s Health.

Dorflinger, L. M., Ruser, C. B., & Masheb, R. M. (2017). Night eating among veterans with            obesity. Appetite117, 330-334.

Hoerster, K. D., Jakupcak, M., Hanson, R., McFall, M., Reiber, G., Hall, K. S., & Nelson,            K. M. (2015). PTSD and depression symptoms are associated with binge eating   among US Iraq and Afghanistan veterans. Eating behaviors17, 115-118.

Klingaman, E. A., Hoerster, K. D., Aakre, J. M., Viverito, K. M., Medoff, D. R., &           Goldberg, R. W. (2016). Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders. General hospital psychiatry39, 1-7.

Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry71(1), 44-51.

Masodkar, K., Johnson, J., & Peterson, M. J. (2016). A review of posttraumatic stress disorder and obesity: exploring the link. The primary care companion for CNS disorders18(1).

Scherrer, J. F., Salas, J., Lustman, P. J., Van Den Berk-Clark, C., Schnurr, P. P., Tuerk, P., … & Chard, K. M. (2018). The role of obesity in the association between posttraumatic stress disorder and incident diabetes. JAMA Psychiatry75(11), 1189-1198.

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