Lifestyle Modification within an Underserved Population: A Case Study Analysis Caitlin Moore, BSN, RN, Michelle Tomevi, Gibbs Wiksell, Heather Berg


Adherence to a healthy balanced diet and physical activity are essential components for the management and reversal of chronic disease. First Line Therapy (FLT) implements lifestyle modification and health coaching techniques while utilizing this framework over a twelve-week period. This research investigates the effect of dietary and lifestyle modifications on 3 voluntary FLT program participants of low socioeconomic status diagnosed with various chronic diseases. The cases highlight varied patient successes including: patient compliance with program completion, patient noncompliance with partial program completion, and patient noncompliance with program cessation. Throughout the program, clients were analyzed through Bioelectrical Impedance Analysis (BIA) as part of their nutritional assessment. The patient who completed the program experienced a weight loss of 13.0 lb, a fat loss of 3.2 lbs and a BMI decrease of 1.9 kg/m². The two patients who did not complete the 12 week program experienced no measurable improvement. Factors influencing program compliance and completion include social support systems, financial means, and subjective stressors. This study concludes that completion of a full 12 week lifestyle modification program produces measurable results within an underserved population and are evidence that the field of lifestyle medicine intervention programs are of increasing importance in a local clinical setting.


The incidence of chronic disease in the United States is largely preventable. Widespread studies support the implementation of physical activity, balanced nutrition and stress management in the prevention and reversal of such conditions 1,2,3,4. In spite of this knowledge, there is a lack of application and implementation of lifestyle interventions to corresponding high-risk populations. The Joseph F. Sullivan Center (JFSC), in Clemson, SC, specifically targets clients from the South Carolina Upstate for lifestyle modification intervention in response to this demand.

First Line Therapy (FLT) is an evidenced based, professionally supervised, personalized lifestyle modification program. FLT targets three major components: dietary management, stress management, and regular exercise. This program promotes healthy body composition and ultimately modifies risks and effects from chronic conditions. Continued implementation and improvement upon the FLT program with the underserved adult population in upstate South Carolina will improve the health status of this group, reinforce healthier behaviors passed down to subsequent generations, and decrease disease exacerbation related costs to the state and to taxpayers.

Through analysis of various patient successes, the group aimed to determine if a twelve-week lifestyle medicine intervention program produces measureable and sustainable improvements in the prevention of chronic disease within an underserved population. Additionally, the group identifies variables to improve success rates in future patients.


Methods used for this case study were collected from three existing, voluntary participants in the FLT program. Through various body measurements, data was analyzed through Bioelectrical Impedance Analysis (BIA) as part of their nutritional assessment. Along with tracking weight and body mass index, the measurements between participants were compared and the factors that lead them to complete, partially complete, or not complete the program.


Client A enrolled in FLT for 131 days. By the completion of the program, patient A experienced a net weight loss of 13.0 lbs, a fat loss of 3.2 lbs and a BMI decrease of 1.9 kg/m² . Client B was not able to complete the FLT program and gain discipline over good eating habits. The client intermittently adhered to FLT for about 2 months, resulting in no weight loss or dietary change, therefore choosing to defer FLT due to a food addiction and inability to obtain a well-balanced nutritional diet. Client C did not complete the FLT program or the milestones set out for her due to the financial burden and lack of motivation. During the FLT program, the client returned to follow up sessions without completing assessments and was noncompliant to the FLT program after a few weeks.

Figure 1: Weight loss and gain throughout program enrollment, in percent change in pounds.
Figure 2: BMI progress throughout program enrollment, in percent of starting BMI (kg/m2)


This research concludes that the success of a twelve-week lifestyle modification program is largely grounded in the creation of personalized plans, financial access to healthy options, and experienced improvement. A twelve-week program produces measurable results when compliance carries throughout the program duration.

This research highlights a need for future implementation to focus on a continuation of personalized goals. Future research should aim to explore the inclusion of supplements into a dietary plan and its influence on results as well as methods to make access to healthy options more feasible within an underserved population.


Gans, K., Risica, P., Strolla, L., Fournier, L., Kirtania, U., Upegui, D., & ... Acharyya, S. (2009). Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults. International Journal Of Behavioral Nutrition & Physical Activity, 6(24), 1-11. doi:10.1186/1479-5868-6-24

Jones, J., Fernandez, M., Mcintosh, M., Najm, W., Calle, M., Kalynych, C., . . . Lerman, R. (2011). A Mediterranean-style low-glycemic-load diet improves variables of metabolic syndrome in women, and addition of a phytochemical-rich medical food enhances benefits on lipoprotein metabolism. Journal of Clinical Lipidology, 5(3), 188-196. doi:10.1016/j.jacl.2011.03.002

Keyserling, T., Samuel-Hodge, C., Jilcott, S., Johnston, L., Garcia, B., Gizlice, Z., . . . Ammerman, A. (2008). Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: The North Carolina enhanced WISEWOMAN project. Preventive Medicine, 46(6), 499-510. doi:10.1016/j.ypmed.2008.02.011

Luisi, M. E., Biffi, B., Gheri, C. F., Sarli, E., Rafanelli, E., Graziano, E., . . . Macchi, C. (2015). Efficacy of a nutritional education program to improve diet in patients attending a cardiac rehabilitation program: Outcomes of a one-year follow-up. Internal & Emergency Medicine, 10(6), 671-676. doi:10.1007/s11739-015-1211-y


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