Voinovich School evaluations show effectiveness of anti-obesity program

After a three-year evaluation, researchers at the Voinovich School of Leadership and Public Affairs have shown that a federally funded program to reduce obesity among adults in northeastern Ohio is an effective way to improve health.

In June 2015, the Voinovich School completed a study of the Trinity Hospital Twin City’s Fit for Life program, which offers a multi-agency approach to reduce the number of overweight and obese adults in Tuscarawas County and in nearby replication sites, which vary in location from year to year based upon needs and resources. During the three-month program, participants meet for 60 to 90 minute classes once a week to discuss not only nutrition and fitness, but also stress management, healthy aging, disease prevention, and other wellness factors not typically covered in traditional weight-loss programs. Participants also follow customized nutrition and fitness plans developed specifically for them by the Fit for Life team.

Dr. Timothy McKnight, certified family physician with Trinity Hospital Twin City, created the program in 2006, at which point it was offered only in Tuscarawas County. However, the program soon received funding from the federal Health Resources and Services Administration’s Office of Rural Health Policy to expand into surrounding counties and conduct the research necessary to turn the program into a replicable best practice. That was when the Fit for Life grant coordinator, Jennifer Demuth, contacted the School to request that a research team evaluate the program. Demuth was familiar with the efficacy of the Voinovich School’s work prior to this evaluation, as she had previously worked on projects with Voinovich School staff.

Beginning in 2012, the Voinovich School’s evaluation team gauged the effectiveness of Fit for Life’s use of resources, measured improvement in the health of program participants, and assessed the success of the program’s replication sites. At least one student assisted the evaluation each year, including graduate assistants, students in the Master of Public Administration program, and Voinovich Undergraduate Research Scholars.

Generally, the results of the evaluation were positive:

• Use of resources: The evaluation found that trainers at each evaluated site, in all three years, successfully taught all 12 weeks of the Fit for Life curriculum. Trainers’ fidelity to the curriculum content improved in the second year and remained strong in year three. Overall, 73 percent of participants completed the program.
• Improvement in participants’ health: According to participant surveys during the final year of the evaluation, 60 percent exercised more often, 69 percent ate more fruits and vegetables, and 65 percent reviewed the nutritional value of foods more frequently after the program. More than 80 percent of participants lost weight — an average loss of 5.5 pounds. Participants also saw an average 2.8 decrease in systolic blood pressure, while 70 percent experienced a decrease in total cholesterol.
• Success at expansion sites: While the goal of having 180 adults in Tuscarawas County complete the program was met, only 118 adults in the surrounding counties completed the course — far from the goal of 450. Participation was lower than anticipated largely because two partner sites withdrew after the first year of the program. However, in the two partner sites that remained, participation was still lower than hoped. Despite this, feedback from those who did participate was overwhelmingly positive: All survey respondents in each of the three years stated they would recommend the program.

Despite low attendance at the expansion sites, the expansion of the program was still successful according to Natalie Wilson, a research associate with the Voinovich School who served as the primary statistician for the Fit for Life evaluations.

“The program is continuing in almost all the counties that had the replication sites, and now it has even developed into a larger program targeting people with diabetes and pre-diabetes,” Wilson said. Furthermore, over the course of the three years the program reached 404 adults overall and participants in the replication sites saw similar health and lifestyle outcomes as those at the lead site.

The program continued to evolve during the evaluation in ways that have made it more successful, she said. For example, Wilson said she saw great improvements the organization of the program’s curriculum — such as PowerPoint presentations and workbooks — that improved the efficacy of the existing replication sites and will make it easier for other communities to replicate.

“Dr. McKnight was able to come up with a very nice curriculum, so that it’s shelf-ready, and people in these other communities can easily replicate it and get the same results,” Wilson said.

When asked whether she sees the project expanding even further, Wilson said, “I would hope so. The HRSA is very pleased with the evaluation results and there’s a lot of interest.”

The Voinovich School is currently continuing its relationship with Trinity Hospital Twin City by evaluating two other projects for the hospital: the Diabetes Care Quality Program, which focuses on giving providers tools to assist patients in diabetes education and management, and the Comprehensive Diabetes Prevention Program, which uses a modified Fit for Life curriculum with individuals who are at-risk for or were recently diagnosed with diabetics.