It often takes a decade or longer in health services research to begin affecting real and lasting change. Stephanie Fitzpatrick is on a fast track.
Fitzpatrick has devoted her career to fighting obesity, diabetes and cardiovascular disease. An expert in the development, implementation, and analysis of behavioral interventions, Fitzpatrick’s techniques have been successful in settings ranging from small family practices to large integrated health systems such as the one at Kaiser Permanente.
The lead or co-author of 34 peer-reviewed journal articles, Fitzpatrick was previously an assistant professor in the Department of Preventative Medicine at Rush University Medical Center, where she worked in a multidisciplinary clinic specializing in weight, diabetes and hypertension management.
Among many other accomplishments, her work in diabetes prevention helped lead to a landmark decision directing federal payers to cover behavioral lifestyle intervention.
What is health psychology and how does this discipline contribute to health care practice today? Health psychology examines how psychological, biological and social factors influence health as well as the prevention and management of illness. Health psychologists have expertise in health behavior change and contribute to the care of patients in many integrated health care settings across the country. As we have come to better understand the relationship between psychological factors and health, it is now widely accepted that behavioral modifiable risk factors such as diet, physical activity and smoking play a major role in chronic disease prevention and management. ... A great example of this is the work being done in stress management.
What is one finding in your research that has really moved your work forward? Most of my research has focused on analyzing the effects behavioral interventions for obesity and obesity-related illnesses have on health outcomes. In my work, I have seen repeatedly the vast differences in individual clinical outcomes among those who participate in a behavioral weight-loss intervention. One size does not fit all. I have learned that tailoring an intervention to the needs of the individual is the key to that individual successfully making lifestyle changes, maintaining those changes, and realizing the accompanying health benefits long-term. ... I consider cultural and psychosocial factors such as race and ethnicity, age, gender, education, mental health — even neighborhood and home environment — to make sure the intervention is appropriate and therefore more effective for more people.
What are a few things clinicians can do to better address obesity during a patient encounter? My colleagues and I have published some guidelines on how to apply a specific counseling framework we think works extremely well in addressing obesity in a clinical setting. The framework is called the "5As," and stands for assess, advise, agree, arrange and assist. It has been used to address not only obesity, but also smoking during patient encounters. Our paper, which was published in the American Journal of Medicine, provides a detailed description of the ‘5As’ framework.
What is the success rate of a behavioral weight management program? Across clinical trials, 40 to 60 percent of participants in intensive behavioral weight management programs lose, on average, 8 to 10 percent of their initial weight. This may seem like a modest weight loss, but even losing as little as 5 percent of initial weight has been associated with a significant reduction in risk for diabetes, decrease in blood pressure, improvement in cholesterol and improvement in physical functioning and mobility. Of course, 40 to 60 percent of participants with success means there are 40 to 60 percent of participants across clinical trials who are not as successful, which goes back to my earlier point about the importance of tailoring these programs and considering the cultural and psychosocial factors that may influence outcomes.
You’re taking on gigantic challenges. You don’t seem like the type to take guff from playground bullies. What were your interests as a child? The main part of my passion for this work comes from my personal experience with these conditions. I have struggled with obesity since childhood and I have several family members with diabetes and cardiovascular disease. Over the years, I have learned how important behavior change is to overall well-being and quality of life. And I’m not talking about major behavioral changes, but small behavioral changes that add up over time to improve health outcomes.
You excel at transferring your research to practical applications. What personality traits do you have that make you good at this delicate skill? I would have to say a mix of patience and persistence, but more importantly, a willingness to listen to others and a spirit of collaboration. Throughout my training and career, I have had the great opportunity to work on multidisciplinary teams, which has helped me to see the problem at hand from other perspectives, but also the richness of ideas for possible solutions that comes from working with a diverse team.
Do you get push-back from clinicians when trying to implement new procedures? I think it is important to understand that clinicians are continually required to keep up with new guidelines and procedures, and it is really challenging to cover all of these during a single patient encounter. In my qualitative work with clinicians, the common message is, "Simple is better."
What career accomplishment are you most proud of? As a researcher, I am most proud of my recent success in obtaining funding from the National Institutes of Health to further pursue my work in implementing evidence-based behavioral interventions in clinical practice. As a clinician, I am most proud of the opportunity to work with patients from diverse backgrounds to help them achieve their weight loss and overall health goals and celebrate with them when they do.
What do you most hope to accomplish with your career? Through my research and clinical practice, I hope to play a major role in creating a model of care for obesity in integrated health systems. Obesity is the underlying cause of many of the most highly prevalent, high-cost chronic diseases, and it is time we put more effort into addressing this issue and preventing further incidence of diabetes and cardiovascular disease.
What’s your greatest challenge right now? Obtaining funding to continue this work is my greatest challenge. In today’s increasingly competitive research environment, researchers like myself are vying for extremely limited funds, in particular, those coming from federal sources.
5 UNDER 40 AWARDS
Celebrates five young health care professionals of Oregon or S.W. Washington companies who have already made a significant impact on their respective organizations and on the improvement of health care delivery
ABOUT THE WINNER
Name: Stephanie Fitzpatrick, Ph.D
Age: 36
Job title: Investigator, clinical health psychologist
Job details: Develops embedded behavioral interventions for obesity and chronic disease management at the Kaiser Permanente Center for Health Research