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College of Nursing > Faculty Funded Research
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Although overall obesity rates are declining in the US, severe obesity (BMI > 35 kg/m2) is still increasing; rates are as high as 36% in some US ethnic minority populations. Bariatric surgery is the most promising treatment for weight loss in the severely obese, resulting in much higher excess weight loss (75% vs. 11%) than traditional behavioral methods. The most frequently used bariatric procedures (bypass and gastric sleeve) have clear evidence for durable weight loss, however, even within the same procedure type, weight loss varies substantially. For example, 25% - 50% of RYGB patients regain some of their initial weight lost within 3 years. We propose a unique, mixed methods, prospective cohort study to understand why some patients experience better weight outcomes than others. The healthcare setting for this work, Kaiser Permanente Southern California (KPSC), performs ~3,500 bariatric surgeries annually; a larger target population for prospective research than any other single institution. Using socio-ecological, self-regulatory, and social cognitive theories fo the basis of our study design, we propose to collect electronic medical record data and self-report surveys in 1,800 patients before surgery and at 12, 24, and 36 months post-operatively to examine demographic, behavioral, psychosocial, and perceived environmental predictors of weight loss/regain. We will also purposively select cross-sectional samples from 12-, 24- and 36-month survey respondents who do or do not achieve successful weight loss to participate in interviews and focus groups. We will test the following two main study aims and one exploratory aim: Aim 1. Over a 3-year follow-up period, determine how demographic, behavioral, psychosocial, and perceived environmental pre-surgical factors, and post-surgical behavioral and psychosocial factors predict a) the weight loss trajectory and b) weight loss success (defined as achieving and maintaining > 50% excess weight loss); Aim 2. Understand the variability in weight loss using qualitative methods in cross-sectional samples of post-operative survey respondents and use these findings to inform mediational models addressing Aim 1; Exploratory Aim 3. Over a 3-year follow-up period, study the development of adverse psychosocial consequences and determine how they relate to a) overall weight loss and b) weight loss success. Our study is designed to provide results that will move the science forward in two key areas: 1) optimizing patient selection in real-world settings for bariatric procedures using a better understanding of pre-operative predictors; and 2) program development for maximizing the benefits from surgery for the greatest number of people, using the knowledge we gain from studying mediators of post-operative weight loss.
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Theresa Beckie-Herheart Theresa Beckie-Herheart I-CORPS: HERHEART
National Science Foundation Innovation Corps Teams Program (I-Corps Teams)
Tentative Start Date 6/15/2016
Tentative End Date 12/31/2016 (6 months)
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Coronary heart disease (CHD) afflicts nearly 7 million US women annually and remains their leading morbidity and mortality threat. Of these, 2.7 million have a history of myocardial infarction (MI), and an estimated 262,000 women are hospitalized annually with an acute coronary syndrome (ACS). Within a year of a first MI more women than men will die. Compared with men, women with ACS and those after coronary revascularization have longer hospitalizations and higher in-hospital mortality and endure up to 30% more readmissions within 30 days after the index hospitalization. Cardiac rehabilitation (CR) is an essential component of comprehensive care after ACS, is internationally endorsed, is integrated in evidence based guidelines for women and reveals incontrovertible morbidity and mortality benefits. Although referral to CR is designated as a performance measure of healthcare quality after ACS, CR has failed to reach over 80% of eligible women in the last 3 decades. Patient-oriented, medical and healthcare system barriers variably account for poor CR attendance among women. Without health insurance, CR costs about $6000 and even with health insurance, women can endure co-insurance payments of up to $50 for each of the 36 CR sessions ($1800). With an increasing ageing population and increasingly more women living with symptomatic CHD, the effectiveness and accessibility of secondary prevention (SP) health services for these women have never been more important. Alternatives to center-based CR programs are nonexistent. Thus, after hospital discharge women struggle with disease self-management without the knowledge or behavioral skills to effectively improve their risk factors for a subsequent cardiac event. Mobile health (mHealth) technology can deliver evidence-based health information and behavior theory based behavior change strategies to help women engage in self-care to manage their risk factors. A mobile application (app), “HerHeart” is an innovative SP intervention for improving reach, reducing cost and time, and improving health outcomes for women with CHD wherever they live. Empowering women with tailored information, intuitive self-monitoring, and personalized goal setting and feedback will transform SP from a 3-month center-based program to a paradigm of life-long engagement in healthy behaviors.
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