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Impact of a Wellness Coaching Program on Bariatric Surgery

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Impact of a Wellness Coaching Program on Bariatric Surgery IMPACT OF A WELLNESS COACHING PROGRAM ON BARIATRIC SURGERY CANDIDATES FOLLOWING WEIGHT LOSS A Dissertation Submitted to the Graduate Faculty of the North Dakota State University of Agriculture and Applied Science By Anita Marie Gust In Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Major Program: Human Development December 2013 Fargo, North Dakota North Dakota State University Graduate School Title Effect of Method of Weight Loss on Health Behaviors and Quality of Life By Anita M. Gust The Supervisory Committee certifies that this disquisition complies with North Dakota State University’s regulations and meets the accepted standards for the degree of DOCTOR OF PHILOSOPHY SUPERVISORY COMMITTEE: Dr. Bradford Strand Chair Dr. Bryan Christensen Dr. Ardith Brunt Dr. Molly Secor-Turner Approved: 12/03/13 Dr. Greg Sanders Date Department Chair ABSTRACT A lifestyle approach toward weight loss, encompassing behavior modification strategies, education, and new coping skills may be most effective in adoption of the healthy behaviors necessary for achievement and maintenance of successful weight loss. Limited research exists on the effectiveness of pre-surgery wellness programs on post- surgical health behaviors for bariatric surgery candidates. The purpose of this study was to determine the impact of a pre-bariatric surgery wellness coaching program on health behaviors, quality of life (HRQoL), and psychosocial factors. A questionnaire containing measures of weight (self-report), dietary and physical activity (PA) (7-day IPAQ-short) behaviors, exercise motivation (BREQ-2), HRQoL (SF- 12v2), and open-ended questions evaluating the wellness program, was sent out to all participants who engaged in a 12-week weight loss wellness coaching program and all bariatric surgery patients from 2009-2012 (n=782). From the 118 returned surveys (15.0%), participants (age = 51.46 years ± 12.98, BMI = 30.31 ± 7.70) were placed in either the wellness-coaching only group (n=16), surgery-only group (n=58), or surgery plus wellness coaching group (n=44) based on whether they participated in, and completed, the 12-week program and/or surgery. The wellness-coaching only group was excluded for the first set of analysis where weight loss, PA, dietary factors, exercise motivation and HRQoL were analyzed between a control (surgery only) group and intervention (surgery + wellness coaching) group. Compared to controls, participants in the wellness-coaching group had significantly more weekly vigorous PA, total minutes of MVPA, and total weekly PA. Significant differences were also found for two measures of exercise motivation and vitality scores. iii The second set of analysis excluded the surgery only group to analyze the impact of the wellness coaching program. Results indicate favorable results for health behaviors. A qualitative analysis found positive results for several psychosocial factors, motivation, and new skills learned. A comprehensive, wellness approach encompassing evidence based strategies toward weight loss had positive results towards health related behaviors and emotional and social well-being. Additionally, participants reported responses consistent with continued engagement in health behaviors and weight loss maintenance. iv ACKNOWLEDGMENTS I would like to thank the many people who helped with the origination, implementation, and completion of this project: Dr. Strand, who agreed to step in as my advisor, for his support, guidance and feedback; Drs. Brunt, Christensen, and Secor-Turner, my committee members for their quality feedback and suggestions; and Dr. Liguori, my original advisor for his original idea in evaluating physical activity in clinical populations. I would also like to thank Ms. Holly Boub and Ms. Sara Johnson and the intern(s) from Sanford Health, Fargo, for their patience and assistance in collecting data. Lastly, I would like to thank Dr. Dittman and Dr. Weidow from Dakota State University, Madison, SD, for supporting this project financially. Thank you, also, to Ms. Billy Hoekman for her efforts in collecting, and forwarding on, the returned surveys. v DEDICATION I would like to dedicate this dissertation to my family, who without their patience, love, and support, this would not have been possible. Tommy (9), thank you for your smiling face and company on those long rides to and from Fargo to our home in Mitchell, SD. Jaeden and Trenton (14 and 17), I appreciate your understanding and patience as well as your help around the house, as I had to dedicate much of my time away from you and home. And my loving husband, Steve, thank you from the bottom of my heart for your love, support, and encouragement as I went through this process. Thank you taking care of things on the home front, for believing in me, and giving me the strength to continue. I would also like to dedicate this to the Joe and Kathy Vasek. Thank you for opening your home and giving me a warm and inviting atmosphere to come to every week for two years. Without your generosity, I would have not been able to accomplish this endeavor. Lastly, I would like to give thanks to God for giving me strength and guidance to accomplish my goal. Without my faith in Him, I would not have succeeded. vi TABLE OF CONTENTS ABSTRACT.......................................................................................................................... iii ACKNOWLEDGMENTS ..................................................................................................... v DEDICATION ...................................................................................................................... vi LIST OF TABLES ................................................................................................................. x LIST OF FIGURES .............................................................................................................. xi CHAPTER I: INTRODUCTION .......................................................................................... 1 Types of Procedures ........................................................................................................... 2 Trends of Bariatric Surgery ................................................................................................ 3 Successful Weight Loss ..................................................................................................... 4 Wellness and Wellness Coaching ...................................................................................... 5 Problems Stated and Purpose of Study .............................................................................. 7 Significance of the Study ................................................................................................... 8 Limitations ......................................................................................................................... 9 Dissertation Organization ................................................................................................... 9 Definition of Terms .......................................................................................................... 10 CHAPTER II: REVIEW OF LITERATURE ...................................................................... 14 Outcomes of Bariatric Surgery ......................................................................................... 14 Weight Loss and Associated Comorbidities ................................................................ 14 Quality of Life .............................................................................................................. 20 Weight Regain .............................................................................................................. 28 Negative Impact of Bariatric Surgery .......................................................................... 29 vii Long-Term Efficacy ..................................................................................................... 30 Factors Affecting Surgical Outcomes .............................................................................. 32 Lifestyle Behavior Change ........................................................................................... 33 Psychosocial Factors .................................................................................................... 40 Exercise Motivation ..................................................................................................... 44 Pre-Surgery Interventions............................................................................................. 50 Other Predictors of Weight Loss Success ........................................................................ 64 Bariatric Surgery vs. Other Weight Loss Methods .......................................................... 68 Wellness Coaching ........................................................................................................... 86 Summary .......................................................................................................................... 90 CHAPTER III: METHODS ................................................................................................. 92 Study Design and Participants ......................................................................................... 92 Wellness Coaching Program ............................................................................................ 92 Tools and Measurements .................................................................................................
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