Advisor(s)
R Drew Sayer
Barbara Gower
Committee Member(s)
Gareth Dutton
Holly Wyatt
Kimberly Smith
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Nutrition Sciences
Date of Award
1-7-2025
Abstract
Obesity is strongly associated with, and effective at, preventing and managing cardiometabolic disease but proponents of Health at Every Size® approaches challenge the importance of weight loss for improving health. While some patients want to lose weight, there is evidence that others desire to focus on improving broader aspects of health and wellness such as metabolic, fitness, and psychosocial health. Clinicians may benefit from a comprehensive understanding of the multifactorial benefits of obesity treatments to effectively capture overall patient wellness. However, existing wellness assessments are often either not comprehensive, unreliable, or subject to time, space, or cost constraints in clinical settings that reduce scalability and research-to-clinic translation. The purpose of this dissertation is to develop a holistic wellness assessment for people with obesity that is scalable, accurate, and inclusive of patient preferences for treatment outcomes. The first study aimed to compare the more scalable method of assessing body composition, considering with bioelectrical impedance analysis (BIA), using dual-energy X-ray absorptiometry (DXA)as the reference criterion. Fat and fat-free mass was measured in n = 28 adults with obesity via BIA in the supine, standing, and seated positions and compared to DXA. Results indicate that measurement while supine is most accurate and precise in this population. The second study aimed to determine if body size and cardiometabolic health measures are distinguishable constructs. An exploratory factor analysis (EFA) of nine items was conducted in n = 249 adults with obesity. Findings indicate that body size and cardiometabolic health are distinguishable, suggesting that obesity treatment outcomes could potentially extend beyond simply weight loss. The third study aimed to develop the holistic assessment for people with obesity. Another EFA was conducted comprising measures of metabolic health, psychosocial health, body composition, diet quality, and fitness. Results suggest retaining 13 items across five dimensions for the obesity wellness assessment and confirmed that body size and cardiometabolic health are distinct constructs. Additionally, body fat percent grouped with fitness measures suggesting it is a better indicator of fitness than body size. Future research should include a confirmatory factor analysis and test implementation strategies for research-to-clinic translation. Keywords: obesity, lifestyle wellness, body composition, exploratory factor analysis, body positivity, cardiometabolic disease
ProQuest ID
Recommended Citation
Ellison, Katie M., "Development Of A Lifestyle Wellness Assessment For Obesity Treatment-Seeking Adults" (2025). All ETDs from UAB. 7270.
https://digitalcommons.library.uab.edu/etd-collection/7270
