Obesity Prevention in Postpartum Women at High-Risk of Cardiovascular Disease

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PROJECT SUMMARY Obesity is a significant risk factor for cardiovascular (CV) disease that affects 39% of adults in the U.S. Obesity rates are disproportionately rising among women and contribute to increasing rates of diabetes and CV mortality among women younger than 55 years. Pregnancy represents a life transition when many women gain excess weight. The effect of obesity is further magnified in women with preeclampsia, an independent and underappreciated risk factor for future CV disease. There is a pressing need to better understand predictors of excessive postpartum weight retention in order to deliver effective and scalable weight loss interventions during a period when women at highest risk may be particularly receptive to lifestyle change. Social incentives, or the influences that impact behavior change based on relationships, are strong motivators of healthy behavior. The use of game design elements, such as goal-setting, has been successfully combined with social incentives to enhance healthy behavior in other disease settings. The central hypothesis of this proposal is that a behavioral intervention using these novel approaches, combined with an established behavioral weight loss program, will provide an effective, and scalable solution to reduce the incidence of postpartum obesity. This proposal will leverage mentorship of senior investigators (Drs. Michal Elovitz and Peter Groeneveld) and Penn’s mature research programs in cardiovascular medicine, maternal fetal medicine, and behavioral economics. Research will be conducted in an urban and racially diverse population since these women are most likely to benefit from interventions to reduce CV risk. Aim 1 will use robust statistical methods and machine learning to create a clinical prediction tool for postpartum weight retention in an existing electronic health record database enriched with neighborhood-level data. Aim 2 will use qualitative and mixed methods to identify strategies to enhance the design of a pilot intervention using patient feedback. Aim 3 will implement a 2-arm single site randomized clinical trial to achieve weight loss in women with preeclampsia or gestational hypertension participating in an online behavioral weight loss program using remote technology and social feedback from other postpartum women. This proposal will identify women at an early stage in life who will benefit the most from intensive lifestyle changes and will test and refine interventions that are able to be disseminated to postpartum women remotely. Dr. Lewey is a general cardiologist trained in women’s health and population science with established expertise in pregnancy associated cardiovascular disorders. The training she proposes in advanced statistical methods, qualitative analysis, and behavioral clinical trial design will position her to become a leader in women’s cardiovascular health. By the conclusion of this program, she will be able to independently design, target, and evaluate behavioral interventions to prevent heart disease in women. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.