Date of Graduation

2018

Document Type

Dissertation

Degree Type

PhD

College

Davis College of Agriculture, Natural Resources and Design

Department

Agricultural and Resource Economics

Committee Chair

Melissa D Olfert

Committee Co-Chair

Stephanie Cox

Committee Member

Ida Holaskova

Committee Member

Lawrence Tabone

Committee Member

Jennifer Walsh

Abstract

Introduction. Overweight and obesity, diabetes, mental health issues, and lack of access to healthcare resources are frequent burdens among the Appalachian region of the United States. With morbid obesity, conventional behavioral interventions tend to fail. Bariatric surgery has been deemed the most successful treatment for morbid obesity and is performed regularly worldwide, however, the Appalachian population with the highest proportions of obesity and related co-morbidities has been poorly studied.;Aims. This dissertation aims to (1) provide a systematic review of the literature surrounding obesity and food access among Appalachian residents, (2) address the void in research of characterizing Appalachian bariatric surgery patients through descriptive statistics of demographic, co-morbidities, psychological scores, nutritional habits, baseline physical measures, and surgical outcomes, and (3) determine Food Access Ranking Scores of an Appalachian bariatric surgery population through Geographical Information Systems (GIS) locating patient addresses and its relationship to descriptive variables.;Methods. A retrospective chart review was performed on bariatric surgery patients who had been enrolled in a bariatric surgery program and completed gastric bypass or sleeve gastrectomy surgery between March 2013 and April 2017. Twenty-four research assistants were trained to retrieve data from over 540 bariatric patient Electronic Medical Record. Data collected from initial visit clinic questionnaires include demographics, socioeconomic status, past and current health status, family history, baseline dietary behaviors and anthropometrics. Repeated anthropometric data was recorded from patients attending one-year follow-up visits. Additional mapping of patient geographical location was conducted to identify rural locality of the population.;Results. In a systematic review, minimal research regarding obesity and food access within the Appalachian region were found. Within the limited findings, although conflicting, most work suggests increasing obesity is correlated with low food access. Our bariatric population was largely defined in the categories of low and moderate-low food access. Lower food access scores were significantly correlated with diagnosed depression and being non-Caucasian. Similarly, within excess body weight loss percentage, variables significantly causing lower excess weight loss at one-year follow-up were patients receiving sleeve surgery type, diagnosed with diabetes, diagnosed with depression, or having a higher baseline Hemoglobin A1c percentage at baseline compared to those receiving bypass surgery, without co-morbidities.;Conclusion. Minimal research has been explored among bariatric surgery patients who live in an area with the largest rates of obesity, co-morbidities and rural locality. This work aimed to fill the void in describing the Appalachian bariatric surgery patient population along with their lifestyle behaviors and health history prior to surgery and how it correlates to their food access and impact surgical outcomes. Findings suggest weight loss surgery in residents of the Appalachian region is successful but, lessen in the conjunction with co-morbidities. Consideration and additional education and support should be given to those diagnosed with diabetes or depression. This research intends to inform future interventions in an Appalachian bariatric population.

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