Evaluation of a Medically Supervised, Multidisciplinary Obesity Management Program on Community Hospital Staff

Abstract

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.