Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

ENMANUEL CHAVARRIA, PHD

Second Advisor

BELINDA M. REININGER DRPH

Third Advisor

ANNA WILKINSON, PHD

Abstract

Obesity puts individuals at risk of developing diabetes, cardiovascular disease, and cancer. Traditionally obesity was primarily perceived as a personal disorder requiring treatment at the individual level. Strategies to prevent obesity have shifted to an ecological approach. Organizations such as the World Health Organization recommend population based community approaches that connect people, families, schools, and municipalities. Community programs to facilitate weight loss are an effective strategy to reach large populations. The overall goal of this study is to assess community programs, factors associated with retention, and motivation for completing a community weight-loss initiative. A systematic review was conducted to characterize and evaluate community-based weight loss programs for adults. Electronic academic databases were searched for studies published between January 2004 and December 2018. The systematic literature search retrieved 1,180 records, with a final synthesis of 11 publications describing eight unique programs. A variety of community strategies were implemented in the selected studies, including changes to the built environment to facilitate active living and healthy eating, and family components All the identified programs described resulted in some percentage of participants losing 5% of their body weight, a decreased BMI, or at least a 1.7 kg average weight loss; this suggests that the diversity in programs and their components is a necessary strategy to meet diverse individual needs across US communities. Understanding what factors help individuals complete weight-loss programs may improve participant retention, thus improving health outcomes. Factors associated with the completion of a community weight-loss challenge were examined. Sample participants included overweight and obese adults (n=6,225) participating in The Challenge. Multivariable regressions showed that the following increased the odds of program completion: increased age, being female, non-Hispanic, receiving text message support, a lower baseline BMI and participating in a group. It is essential to continue to work on increasing completion rates to enhance the effectiveness of community weight loss programs. Research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is lacking. Individual semi-structured interviews were conducted with 20 participants who completed a community weight-loss intervention to assess motivation for participating and the role of social support and self-efficacy. Participants mentioned external sources of motivation, such as preventing adverse health outcomes, wanting to improve their physical appearance, and being motivated by financial incentives. Fewer participants mentioned intrinsic motivators, which are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively. A greater emphasis on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions.

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