Degree Type


Date of Award


Degree Name

Doctor of Philosophy


Food Science and Human Nutrition


Nutritional Sciences

First Advisor

Lorraine Lanningham-Foster


Childhood obesity treatment has become a priority due to the increasing prevalence of

obesity in the United States. Evidence-based recommendations have been developed to guide

treatment using a staged approach, where the first two levels of treatment occur in primary

care with a focus on lifestyle behavior change. The purpose of this dissertation is to explore

lifestyle behavior change in the primary care setting using the staged approach for childhood

obesity treatment by: (1) examining primary care providers’ (PCPs) current practices,

barriers and needed improvements; (2) determining the effectiveness of an intervention for

treatment using a lifestyle behavior screening tool and health coaching; and (3) examining

action plans and experiences of families participating in the intervention. The first study

found that 63% of surveyed PCPs always/often use a screening tool to assess patients’ eating

and physical activity behaviors, but only 41% always/often track these behaviors. PCPs

identified their top treatment barrier as limited time and identified needing better counseling

tools. The second study found that after a six-month intervention using a lifestyle behavior

screening tool and health coaching, participants in the intervention group had greater

improvements in lifestyle behavior change measured by the Family Nutrition and Physical

Activity screening tool compared to the control group, but the difference was not significant

(intervention: 4.86 ± 6.28; control: 0.38 ± 4.6; p = 0.135). However, the effect size (d = 0.88)

is considered to be large. The third study identified that the key differences among action

plans of intervention participants were related to the relationship to a particular lifestyle

behavior, as well as the contextual detail in an action plan. Common themes identified in

participant interviews included accountability, an interest in experiential learning and

resources, and perceived program benefit. Findings of this dissertation support the need for

additional research on behavior change interventions in primary care that promote self-management

of health more broadly, as well as to explore other factors in lifestyle behavior

change (e.g., cognitive skills) that aren’t routinely addressed in current approaches to


Copyright Owner

Maren Mae Wolff



File Format


File Size

170 pages