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Dissertation/Thesis Abstract

Improving Comprehensive Lifestyle Intervention for the Medical Management of Obesity
by Mikhail, Dalia, Ph.D., College of Medicine - Mayo Clinic, 2018, 211; 27994940
Abstract (Summary)

Since 1970 the prevalence rate of adult obesity in the United States (US) has increased dramatically. The Centers for Disease Control and Prevention (CDC) estimate one-third of US adults were overweight (BMI > 25.0 and < 30.0kg/m2) and one-third were obese (BMI ≥ 30.0 kg/m2). Obesity prevalence rates were above 20% in all 50 US states. Obesity-related conditions are serious and can increase the risk of heart disease, stroke, type II diabetes, and some types of cancer. In large part due to these obesity-induced health problems, obesity carries a substantial financial burden, contributing to approximately $147 billion a year in medical costs and is projected to increase by $48-66 billion a year by 2030. There is therefore a considerable health and economic incentive to combat obesity.

Medications, surgery, endoscopic procedures and lifestyle interventions are the main weight loss strategies available to health care providers to manage obesity. There are 5 FDA-approved weight loss drugs that are moderately effective, but quite expensive. Endoscopically placed gastric balloons have been recently approved for weight loss, but they are even more expensive and have to be removed after 6 months. Bariatric surgery remains an alternative for severely obese (BMI > 40 kg/m2) participants who fail less costly and invasive approaches. Comprehensive lifestyle weight management programs provide the foundation for virtually every medical intervention for obesity, even if medications or procedures are indicated. lifestyle interventions provide the cornerstone of obesity management and are prescribed as first-line treatment. Effective comprehensive lifestyle programs use cognitive behavioral interventions to achieve long-term positive changes in physical activity and nutrient intake. There are great variations in the components constituting any given intervention because there is no singular “gold standard” lifestyle intervention.

Currently there are many challenges with lifestyle interventions such as modest weight loss results, sustained weight loss, high dropout rates, and loss of follow up. Current evaluation practices focus exclusively upon end results of weight loss so the reasons behind intervention failures or modest results are not easily discerned. Many times the failures are generically blamed on the programs inability to implement strong behavioral change strategies. However, there are no reliable tools to evaluate the nutrition knowledge component of lifestyle intervention programs.

As part of the Obesity Treatment Research Program (OTRP) in Rochester MN, we collected data on 156 participants. The overall goal of my thesis is to develop and adapt methods that will systematically assess and improve the nutrition education component of a lifestyle intervention.

Aim 1:

To describe the methods of establishing a high intensity, year-long, comprehensive lifestyle treatment program for the medical management of obesity at Mayo Clinic, Rochester, MN, that is consistent with the recommendations of the 2013 American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society Guidelines for the Management of Overweight and Obesity in Adults.

Aim 2:

To evaluate outcomes of the Obesity Treatment Research Program to provide a benchmark for subsequent program improvement interventions.

Aim 3:

To develop a novel weight management nutrition knowledge questionnaire that assesses nutrition knowledge as it relates to weight management. The questionnaire will focus on the nutritional dimensions of five key areas: (1) portion size, (2) energy density of foods, (3) reliable nutrition information sources, (4) alcohol and sugar sweetened beverages, (5) variety of food affects intake.

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Indexing (document details)
Advisor: Jensen, Michael D.
Commitee: Windebank, Anthony J., Roberts, Lewis R., Parker, Alexander, Balls-Berry, Joyce E.
School: College of Medicine - Mayo Clinic
Department: Clinical and Translational Science
School Location: United States -- Minnesota
Source: DAI-A 82/5(E), Dissertation Abstracts International
Subjects: Translation studies, Public Health Education, Social research, Clinical psychology, Health care management, Public health
Keywords: Energy density, Intensive Lifestyle Program, Adult obesity in the United States, Portion size, Sugar sweetened beverages, Weight Loss, Centers for Disease Control and Prevention, Obesity, Lifestyle interventions, Gold standard, Minnesota, Obesity treatment program, Heart disease, Stroke, Type II diabetes, Cancer risk, Healthcare cost mitigation
Publication Number: 27994940
ISBN: 9798691222078
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