Obesity is presently one of the leading preventable causes of mortality and is an increasing issue that affects the workplace. This pilot study investigates the effects of a multidisciplinary obesity management program on employees within a community hospital setting. The purpose of this study is to assess the outcome factors of the intervention and to detect an association between the participants’ biological factors, psychological status, eating behaviors, and lifestyle components to that of their current body weight status. Methods. An evaluation of a tailored obesity management program was conducted in a corporate setting with employees of a large community hospital. The evaluation sought to determine if this program could be efficiently and effectively implemented in this corporate setting. This program also allowed an exploration of those sociological, biological, and behavioral factors that were associated with weight loss. An employee health outcomes assessment visit was used to identify, recruit and enroll overweight employees into a quasi-experimental study designed to evaluate potential impacts of a tailored weight management program. The 6-month intervention included medical assessments, nutritional coaching, activity counseling, and behavioral therapy. The following specific aims were proposed for this dissertation research: Specific Aim 1 sought to evaluate the effectiveness of the multidisciplinary weight loss program to change a series of modifiable health risk factors, body composition, clinical indicators, and biological markers from baseline to 6 months for overweight participants. Specific Aim 2 evaluated factors associated with achieving weight loss and patterns of attrition from the program. Weight and lifestyle factors included onset of obesity, family history, weight loss history, weight loss goals, self-perceptions, physical activity factors, and eating habits/patterns. Within Specific Aim 3, we determined if body composition measurements [body mass index (BMI), weight, basal metabolic rate, fat mass, percent fat, fat free mass, and total body water] correlated with standing or supine measurements of waist, hip, or thigh circumferences. We also investigated if there was a significant difference between recording measurements made in both positions. This aim sought to determine if both sets of position measurements needed to be included for subsequent weight management studies. Results. Forty-six (46) employees, with a mean age of 48.6 +/- 10.9 years and predominately female (91.3%), consented to participate in the pilot intervention, with 26 participants completing the 6 months (response = 50.9%). Statistically significant changes from baseline were seen at 6 months in the 44 participants that continued in the study after enrollment. In the intent to treat analysis, the participants, regardless of completion status, had a clinically significant (p<.0001) mean percent weight loss of 4.1% and a total weight loss of 9.3 pounds, with a corresponding 5.6% mean weight loss in those participants that completed the program. When analyzing predictors of attrition from the program, models indicated significant associations between overall program attrition and an increase in baseline systolic blood pressure (p=0.02), along with decreased compliance with eating three meals per day (p=0.04). Primary attrition (dropout < 3 months) was statistically associated with an increase in baseline systolic blood pressure (p=0.02) and decreased compliance with eating three meals per day (p=0.01). Secondary attrition (dropout between 3-6 months) was associated with decreased compliance with eating three meals per day (p=0.05) and an increase in weight loss expectations during the intervention (p=0.05). The mean absolute difference between the two techniques (standing vs. supine) was 4.14 inches for waist, hip, and thigh measurements combined. An increase in body mass index was associated with a greater magnitude of discrepancy in the measurement between the two techniques for waist circumference (p=0.02). Conclusions. The changes seen following this multidisciplinary intervention were clinically significant and advantageous for the participants. These substantial results suggest that the use of multidisciplinary weight management programs merits further investigation in larger, randomized, controlled trials.

Pediatric obesity has become a major health care concern over the last several decades. This condition can lead to detrimental life-long physical and mental comorbidities. Pediatric primary care providers have a unique opportunity to both prevent and treat pediatric obesity in their clinics. However, discussing this topic with families can be uncomfortable and time consuming. Time efficient resources to educate and increase confidence are needed to improve the management of pediatric obesity. This quality improvement project integrated the Healthy Care for Healthy Kids by the National Institute for Children's Healthcare Quality (2014) into the electronic medical record at a pediatric primary care office in rural East Tennessee. This toolkit included handouts, management algorithms, and provider education for pediatric obesity. After an 8-week implementation period, improvements in lab draws and evaluation of a family's readiness to change were noted. Overall, providers reported the toolkit was helpful and improved patient interaction. Currently, the clinic is still utilizing the integrated resources and handouts.

The opportunity to educate obese patients on healthy lifestyle practices and address habits related to chronic disease development is present among many physician office visits, though this opportunity is often overlooked (Flocke, Stange, & Goodwin, 1998). Understanding ways to improve the medical education and enhance the counseling skills of future physicians are of practical and personal relevance to current research. By improving the ways in which physicians counsel obese patients on weight management practices, the healthcare paradigm is poised to create an indelible mark on the wellbeing of our nation. Based on the need to address patient education and counseling, the purpose of this study was to investigate the relationship between physician attitudes and health behaviors on their overall communication and communication skills. The study surveyed 38 second-year medical residents at the New York University Bellevue School of Medicine using the Weight Management Survey developed by NYU researchers. Communication and counseling skills were measured using scores from Objective Structured Clinical Exams (OSCEs) administered on the same day as the Weight Management Counseling survey. Results of the survey and the OSCEs were analyzed to investigate relationships between each survey item of three categories of questions (attitudes toward weight management counseling, attitudes toward obese patients, physician health habits) and each of two sets of OSCE scores (obesity-related communication skills and overall counseling skills). Results of the data analysis suggest significant relationships between physicians' personal health habits–specifically dietary habits–and obesity counseling–related communication skills. Results also suggest a significant relationship between physicians' attitudes toward obesity counseling-related communication skills and overall communication skills. Although an extensive body of evidence corroborates these relationships, future investigations should administer the surveys and methods used in this study in rural as well as other urban locations in order to improve variability among medical residents surveyed and assessed. These results also highlight the need to investigate more information about the learning environment of medical residents and also the working environment of physicians, in a variety of settings, in order to provide more depth to the body of literature suggesting providers' health habits improves patient health outcomes. / Ph. D.

Background: There are treatments available to manage overweight and obesity (O&amp;O). Intragastric balloons (IGB) are one option; they fill the stomach, increasing the sensation of satiety, limiting the amount of food to be ingested, and thus leading to weight loss. However, data suggest that patients regain weight long-term after an IGB treatment. As IGB is a relatively recent procedure for O&amp;O, there is limited information about patient care practices alongside treatment, and whether could explain success or failure to maintain weight loss long-term.  Objective: The aim of the study was to explore clinical dietitians’ perspectives on patient care practices alongside IGB procedures. Method: Six semi-structured qualitative interviews were recorded, transcribed, and explored using qualitative content analysis method, which resulted in three categories. Results: The results showed that the clinical dietitians had many practices in place to condition patients before treatment. Screening the patient, balloon role information, and setting realistic expectations were considered essential practices. The involvement of a multi-disciplinary team was viewed as a critical factor to ensure engagement and follow-up with patients. The findings showed a high level of variability of frequency and contact during treatment and after balloon removal. Developing patients’ self-efficacy through practices like motivational coaching, dietary education, and behavioural therapy were also common practices.  Conclusion: Although similar practice patterns were identified, the findings highlighted a high level of variability in practices between respondents’ workplaces. This study was a first attempt to explore dietitians’ perceptions on patient care practices in relation to IGB-treatments, and it is too early to determine whether differences in practices have any impact on long-term weight loss maintenance. These could be the focus of new studies. / Bakgrund: Olika behandlingar är tillgängliga för att hantera övervikt och fetma. Intragastriska ballonger (IGB) är ett alternativ; de fyller magen, ökar mättnadskänslan, begränsar mängden av mat som kan intas och leder därmed till viktminskning. Data tyder dock på att patienter långsiktigt går upp i vikt långsiktigt efter IGB-behandling. Eftersom IGB behandlingar är en relativt ny procedur för övervikt och fetma, finns det bara begränsad information om patientvårdsprocesser som används i samband med behandlingen, och om skillnader i dessa skulle kunna förklara framgång eller misslyckande med att upprätthålla viktminskning långsiktigt. Syfte: Syftet med studien var att utforska dietisters perspektiv på patientvårdsprocesser och stödmetoder i samband med IGB-behandlingar. Metod: Sex semi-strukturerade kvalitativa intervjuer spelades in, transkriberades och analyserades enligt kvalitativ innehållsanalysmetoden, vilket resulterade i tre kategorier. Resultat: Resultaten visade att dietister använde många processer/metoder för att förbereda patienten innan behandling. Patientundersökning, ballongsinformation och att sätta realistiska förväntningar ansågs vara väsentliga metoder. Engagemang av ett multidisciplinärt team sågs som en kritisk faktor för att säkerställa engagemang och uppföljning med patienten. Resultaten visade en stor variation av frekvens och kontakt från vårdpersonalen under och efter IGB-behandling. Att utveckla patientens förmåga att ta eget ansvar med metoder som motiverande samtal, kostundervisning och beteendeterapi var också vanliga. Slutsats: Även om liknande processer/metoder identifierades, resultaten visade en stor variation i praktiken mellan respondenternas arbetsplatser. Studien var ett första försök att undersöka dietisters uppfattningar om patientvårdsprocesser i samband med IGB-behandling, och det är för tidigt att avgöra om skillnader i metoderna har någon inverkan på patienternas viktminskning underhåll långsiktigt. Dessa kan vara i fokus för nya studier.