Date of Award

8-2018

Degree Name

Doctor of Philosophy

Department

Psychology

First Advisor

Dr. R. Wayne Fuqua

Second Advisor

Dr. C. Richard Spates

Third Advisor

Dr. Scott Gaynor

Fourth Advisor

Dr. Sara Beth Custodio

Keywords

Obesity, behavioral intervention, primary care, adult obesity

Abstract

Obesity is a chronic health condition with prevalence rates that have continued to rise steadily over the past 30 years to the point that it has now been declared a global epidemic and a serious public health concern. Obesity is associated with significant physical and economic costs, primarily resulting from co-occurring health conditions that increase the risk of morbidity including type II diabetes, hypertension, dyslipidemia, stroke, coronary heart disease, and respiratory problems. Despite the dissemination of several obesity treatments, including pharmacotherapy, lifestyle modification, and bariatric surgery, the prevalence and severity of obesity continues to rise. Federal guidelines recommend the use of lifestyle interventions involving behavioral strategies to reduce caloric intake and increase physical activity, yet there is limited research examining the effectiveness and feasibility of delivering these interventions in community settings, particularly within primary care medical offices. Primary care providers (PCPs) play a critical role in diagnosing, monitoring, and treating obesity and co-morbid health conditions, yet there are many barriers to implementing lifestyle interventions in primary care including time, resource, and knowledge constraints.

The current study evaluates the effectiveness and feasibility of a brief behavioral intervention for obesity delivered by PCPs in an outpatient internal medicine office. Physician training and regular electronic between visit check-ins are utilized to address commonly cited barriers to the delivery of lifestyle interventions in primary care. Outcome variables included weight and BMI as well as severity measures of common obesity-related health conditions including sleep quality, depression, diabetes, hypertension, and hyperlipidemia.

Participants (N = 31) received either brief behavioral intervention (n = 15) or usual care (n = 17) for obesity, depending on their pre-existing PCP, over a 12-month period. Linear mixed modeling analysis revealed a statistically significant difference in rates of change for hemoglobin A1c over time between participants in the behavioral intervention and usual care conditions. Specifically, A1c values decreased for those in the intervention group and increased for those in the usual care group. No other statistically significant results were found and data trends revealed mixed results for the remaining outcome variables. Consumer satisfaction data for the behavioral intervention revealed high feasibility and usefulness ratings from PCPs and patients.

These findings reveal that the brief behavioral intervention, though viewed as valuable and feasible by both PCPs and patients, resulted in statistically significant improvement in only one obesity associated health condition over time relative to usual care. The current study is limited by a small sample size and inconsistent data collection across participants and time points, however, these results have implications for the development of a population-based tiered model of care for obesity. It is possible that the brief behavioral intervention used in the current study could be a first level intervention that might be particularly effective for specific sub-populations, whereas others may need additional levels of intervention. Future research should continue investigating effective implementation of behavioral interventions for obesity in community settings including primary care.

Access Setting

Dissertation-Open Access

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