Date of Award

1-1-2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Marney A. White

Abstract

While responses to the obesity epidemic have largely encompassed top-down approaches with a focus on health-related outcome evaluation, for successes to be sustained, a greater emphasis is needed on local initiatives and intervention process evaluation. Pediatric weight management programs in the healthcare and community settings represent local initiatives that have had considerable health-related impacts, yet are often limited by high attrition rates. Because adolescence is marked by substantial weight shifts and the formation of long-lasting health habits, it represents a critical point for implementing obesity prevention and treatment. Accordingly, this study sought to assess factors that promote adolescent participant engagement with the Yale Bright Bodies healthy lifestyle program, a 12-week program for children ages 7-16 in New Haven, CT. Through adolescent and instructor surveys, adolescent engagement was examined in relation to program-related factors and weight outcomes—with additional insight into the program process offered through program observations. Despite the high attrition often seen in this setting, over half of this diverse, inner-city sample completed ≥ 3 12-week program cycles (≥ 36 weeks). Moreover, improvements in body composition were observed, with significant reduction in starting and ending body fat percentages (p=0.012) and borderline significant reduction in BMI (p=0.055). Adolescents and instructors highlighted the importance of the instructor-participant and participant-participant bonds, engaging activities, and a family-based approach. In support of these findings, higher adolescent rankings of instructor-related factors were significantly correlated with positive weight outcomes. Because adolescents highly valued the relationships with program instructors, future efforts should evaluate the impact of instructor-adolescent relationship building on program retention/attrition and weight outcomes in other settings where adolescents have consistent, supportive relationships with clinicians.

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