Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women A Randomized Clinical Trial
Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women A Randomized Clinical Trial
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DOI：
10.1001/jama.2017.7119
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发表时间：
2017-06-20
影响因子：
120.7
通讯作者：
Tate, Deborah F.
中科院分区：
文献类型：
--
作者：
Phelan, Suzanne;Hagobian, Todd;Tate, Deborah F.
重要性产后体重保持增加肥胖和相关发病率的终身风险。对于多元文化、低收入的妇女，几乎没有有效的干预措施。目的：为了测试除了妇女、婴儿和儿童特别补充营养计划之外，（WIC计划）的低收入产后妇女在12个月内可以产生比WIC计划更大的体重减轻。设计、设置和参与者12个月，随机分组，评估者盲法，2011年7月至2015年5月期间，在加州中部海岸的12家WIC项目诊所招募了371名成年产后妇女，数据收集于2016年5月完成。（标准护理组）或WIC计划加上12个月的主要基于互联网的减肥计划（干预组），包括一个每周课程的网站，网络日记，教学视频，计算机反馈，短信，主要结果和测量主要结果是基于基线、6个月和12个月时的测量结果，12个月时体重变化。次要结果包括恢复到孕前体重的比例以及体力活动和饮食的变化。结果参与者包括371名妇女（平均年龄28.1岁;西班牙裔，81.6%;平均体重高于孕前体重，7.8 kg;平均产后月数，5.2个月），随机分为干预组或标准护理组; 89.2%的参与者完成了研究。与标准护理组相比，干预组的平均12个月体重减轻更大。12个月后，干预组恢复受孕前体重的参与者比标准护理组多。干预组和标准护理组在12个月的体力活动、卡路里摄入量、或从基线至第6个月的损伤或母乳供应不足的发生率（干预组61名参与者中的21名vs标准护理组72名参与者中的23名），（干预组32名参与者中的13名对标准护理组37名参与者中的14名）。结论和相关性在低收入产后妇女中，除了妇女、婴儿、和儿童（WIC计划）相比，单独的WIC计划在12个月内导致了统计学上显著的更大的体重减轻。作为WIC计划的一部分，需要进一步的研究来确定计划和成本效益。
IMPORTANCE Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women.OBJECTIVE To test whether an internet-basedweight loss programin addition to the Special Supplemental Nutrition ProgramforWomen, Infants, and Children (WIC program) for low-income postpartumwomencouldproducegreaterweight lossthantheWICprogramaloneover 12months.DESIGN, SETTING, AND PARTICIPANTS A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016.INTERVENTIONS Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics.MAIN OUTCOMES AND MEASURES The primary outcomewasweight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconceptionweight and changes in physical activity and diet. RESULTS Participants included 371women (mean age, 28.1 years; Hispanic, 81.6%; meanweight above prepregnancyweight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group or standard care group; 89.2% of participants completed the study. The intervention group produced greater mean 12-monthweight loss compared with the standard care group. More participants in the intervention group than the standard care group returned to preconceptionweight by 12 months.[GRAPHICS].The intervention group and standard care group did not significantly differ in 12-month changes in physical activity, calorie intake, or incidences of injury or lowbreastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group).CONCLUSIONS AND RELEVANCE Among low-income postpartumwomen, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program forWomen, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program.