University of Illinois Urbana-Champaign

Development of effective, accessible, and sustainable dietary weight loss program

Lee, Mindy

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LEE-DISSERTATION-2022.pdf

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https://hdl.handle.net/2142/116072

Description

Title
Development of effective, accessible, and sustainable dietary weight loss program
Author(s)
Lee, Mindy
Issue Date
2022-07-15
Director of Research (if dissertation) or Advisor (if thesis)
Nakamura, Manabu
Doctoral Committee Chair(s)
Erdman, John
Committee Member(s)
  • Prescott, Melissa
  • Hsu, Jennie
Department of Study
Nutritional Sciences
Discipline
Nutritional Sciences
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
  • Obesity
  • Chronic disease
  • Education
  • Knowledge
  • Weight management
  • Nutrition
  • Protein
  • Fiber
Abstract
Introduction: Obesity is a significant health issue in the United States and increases the risk of developing chronic diseases. However, no reliable dietary weight management program is widely available due to low success rate, low sustainability, and overpriced programs. The goal was to develop an effective, accessible, and sustainable dietary weight loss program by addressing the shortcomings of existing programs. The core principle is to help participants discover a sustainable diet for weight management through self-experimentation with an emphasis on increasing protein and fiber and reducing caloric intake. The objective of the Individualized Diet Improvement Program (iDip) study was to test if an effective weight loss program can be built upon two forms of quantitative visual feedback: 1) protein-fiber (PF) plot for diet and 2) weekly weight chart for energy balance monitoring. The objective of the iDip 2 was to improve the success rate and the magnitude of weight loss, explore factors that hinder success in weight loss, and investigate weight outcomes after a one-year follow-up. The final study was to develop an interdisciplinary online weight loss program, EMPOWER, and evaluate its efficacy at 6 months. Methods: iDip 1 was a one-year intervention followed by a six-month follow-up study with a before-and-after design. Adults with overweight or obesity completed 19 in-person, group education sessions and 3 in-person individual advising meetings. Participants received individualized feedback via a weekly weight chart to monitor energy balance and a periodic PF plot to help participants make informed-decision on food selection by utilizing a spatial presentation of quantitative values of protein and fiber per calorie for easy comparison of nutrient content. Twenty-four-hour dietary records, food frequency questionnaire (FFQ), anthropometric measurements, and daily weights via a Wi-Fi-enabled scale were collected. iDip 2 was a one-year intervention followed by a one-year follow-up trial with a before-and-after design. The study followed a similar design as iDip 1, but participants were given homework assignments after each session, and feedback was provided. During the follow-up year, participants received weekly weight charts as visual feedback along with short messages provided by the advising team. In iDip 2, body composition was measured in addition to daily self-weighing reported via Wi-Fi scales and dietary intake. The final study, EMPOWER, an online dietary weight loss program, is an ongoing one-year intervention with a one-year follow-up study. EMPOWER comprises 19 online sessions (eText) and 3 individual virtual coachings. MealPlot, a mobile application that employs a weight chart and the PF plot, was developed and used for the study. The same outcomes measures as iDip 2 were collected. Results: In the first iDip study, 12 out of 14 (86%) participants completed a one-year intervention and achieved -5.4(5.8)% (mean[SD])weight loss at 12 months. The number of participants who achieved clinically significant weight loss (>5% of initial weight) was 5 (42%) and 6 (50%) at 6 and 12 months, respectively. Protein intake per energy was significantly increased at 2 months and was sustained throughout the study. In iDip 2, 22 of 30 participants (73%) completed the 1-year program with a mean weight loss of -6.5(8.5)%. At 12 months, 2 participants already achieved a healthy target weight (BMI<25), 23% achieved a weight loss of >10% baseline weight, and 45% reached medically significant >5% weight loss. Nearly half the participants, 9 of 20 who completed the follow-up year, maintained the lost weight over two years, whereas the remaining participants either did not lose weight or regained weight. A large difference in weight loss outcomes was seen among the groups, possibly due to a difference in dietary implementation. Early weight loss success and early dietary implementation was predictive of long-term success. Participants with depression was less successful in weight loss In the final study, the mean weight loss of participants (n=30) was -6.5(5.7)%. At 6 months, 10 participants (33%) lost >10% of initial body weight, and 16 (53.3%) achieved a clinically meaningful weight loss of >5% of initial body weight. Participants who lost weight successfully also showed higher protein density in diets. Conclusion: In iDip1, half of the participants successfully lost >5% and maintained the lost weight for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach to food selection. In iDip2, although variable weight loss outcomes were seen among participants, the top-tertile group maintained their lost weight for 2 years. An online program, EMPOWER, resulted in successful weight loss and showed a low attrition rate. The successful weight loss was also accompanied by higher protein density.
Graduation Semester
2022-08
Type of Resource
Thesis
Handle URL
https://hdl.handle.net/2142/116072
Copyright and License Information
Copyright 2022 Mindy Lee

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