DOI
https://doi.org/10.25772/VCM3-7742
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Nursing
First Advisor
Lisa Shah, PhD
Second Advisor
Jo Robins, PhD
Third Advisor
Patricia Kinser, PhD
Fourth Advisor
Amanda Gentry, PhD
Abstract
Background: Obesity is a complex chronic disease that conveys significant health risk. Women with obesity are at greater risk for associated conditions including heart disease, hypertension, ischemic stroke, and sex-specific cancers compared to their male counterparts. Midlife may present unique challenges for women as it is during this life phase that they experience an increase in their overall obesity prevalence and severity. Some midlife women experience treatment resistant obesity (TRO), a phenomenon not previously explored in the research literature, conceptualized as failure to achieve clinically meaningful weight loss of ≥ 5% after having received medically specialized obesity care for one year. The purpose of this study was to determine the prevalence of TRO among midlife women and to identify biopsychosocial factors associated with the condition.
Methods: For this research, a retrospective data analysis was completed using information collected from the electronic health records of 203 midlife women with obesity between the ages of 40 – 60 years old who received one year of care from a metabolic weight management clinic led by providers certified in obesity medicine. Quantitative methods of analysis were utilized to determine the prevalence of TRO among midlife women and evaluate for associations between TRO and the biopsychosocial factors of age, baseline BMI, race and ethnicity, number of office visits, insurance status, dietary modifications, physical activity, sleep, stress coping, and the use of pharmacotherapeutics for obesity management.
Results: The findings from this study indicate that more than a quarter, 27.5%, of the midlife women who received medically specialized obesity care for one year demonstrated TRO. Only two of the identified biopsychosocial variables demonstrated associations with TRO. The use of FDA approved injectable medications for the management of obesity was associated with TRO among midlife women in that those who were not using these medications were three and a half times more likely to have TRO (OR = 3.49, p = 0.0002). The dietary modification of lowering carbohydrate intake was also associated with TRO in that those who did not incorporate this modification into their diet were twice as likely to demonstrate TRO. While these two factors together, use of FDA approved injectables and a diet lower in carbohydrates, resulted in a statistically significant final multivariable logistic regression model (X2 18.55 (DF 2) p = < 0.001) they do not fully explain all the variation within the population of midlife women with TRO (RSquare = 0.07).
Conclusions: More than a quarter of midlife women with obesity who receive medically specialized obesity care from providers certified in obesity medicine may fail to achieve clinically meaningful weight loss of ≥ 5% total body weight after one year and demonstrate TRO. The use of FDA approved injectable medications for obesity and following a diet lower in carbohydrates are recommendations that providers can offer to midlife women with obesity to mitigate their risk of TRO. Incorporation of these two treatment strategies alone does not eliminate the occurrence of TRO among midlife women. Additional research into the phenomenon of TRO among midlife women and its associated biopsychosocial factors will be necessary to develop more efficacious treatment strategies for this at-risk population.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-6-2025