Reducing Obesity in Underserved Postpartum African American Women

减少服务不足的产后非裔美国妇女的肥胖

• 批准号: 7935024
• 负责人: Caroline M Apovian
• 金额: $ 19.55万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7935024
• 关键词: 20 year old; Address; Adult; African American; American; Appointment; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Birth; Body Weight Changes; Body Weight decreased; Body mass index; Boston; Calories; Caring; Caucasians; Caucasoid Race; Chronic; Chronic Disease; Clinic; Clinical; Clinical Nutrition; Comorbidity; Country; Dancing; Data; Development; Diabetes Mellitus; Diagnosis; Diet; Discipline of obstetrics; Disease Outcome; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Energy Intake; Ensure; Evaluation; Exercise; Fatty acid glycerol esters; Feedback; Food; Future; Goals; Health; Health Promotion; Health Services Accessibility; Health behavior; Healthcare; Heart Diseases; High Prevalence; Hip region structure; Hospitals; Humulus; Infant Care; Intervention; Interview; Life Style; Link; Literature; Low income; Maintenance; Measures; Medicaid; Medical center; Methods; Modeling; Neonatal; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Overweight; Participant; Patients; Physical activity; Pilot Projects; Population; Postpartum Period; Postpartum Women; Pregnancy; Prenatal care; Prevalence; Process; Professional counselor; Publishing; Randomized Controlled Trials; Relative (related person); Research; Research Personnel; Risk; Role; Scientist; Sister; Social support; Specialist; Stroke; Subgroup; Surveys; Target Populations; Techniques; Testing; Time; Training; Underserved Population; Uninsured; United States; Vulnerable Populations; Weight; Weight Gain; Woman; Women' s Health; Work; arm; base; behavioral/social science; care delivery; care seeking; clinical care; cooking; diabetes prevention program; diet and exercise; experience; good diet; health disparity; impaired glucose tolerance; improved; innovation; intervention program; meetings; obesity risk; peer; prenatal; programs; public health relevance; racial and ethnic disparities; response; secondary outcome; skills; social science research; success; successful intervention; weight maintenance

DESCRIPTION (provided by applicant): The prevalence of obesity among African American women in the United States is higher than it is in most other subgroups. In 2005-2006, 52.9% of African American women aged 20 years and older were obese compared with 32.9% of white women. In addition to the obesity disparity, although many African American women attempt weight loss in the US, they are not as successful at weight loss as Caucasian women. There is a need for culturally-tailored interventions to address this important health disparity in obesity and weight loss success. The postpartum period may offer an optimal opportunity to reach overweight and obese African American women for behavioral intervention; this time is a period women are especially tied to clinical care and highly motivated to lose weight. Our current proposal, entitled Reducing Obesity in Underserved Postpartum African American Women, develops and pilot-tests a culturally-tailored, clinic-based weight management program (diet and exercise-focused) to reduce obesity among postpartum African American women. Specifically, the program adapts a multi-session effective weight loss program demonstrating success with patients contending with impaired glucose tolerance, the Diabetes Prevention Program (DPP), combined with culturally-tailored patient navigation strategies to support clinical care utilization and health promotion behaviors in our target population of obese postpartum African American women. Peer counselors (Birth Sisters) will serve as patient navigators supporting program participation and health care access. The specific aims of this project are to: 1a) pilot-test a culturally-tailored, clinic-based weight loss program with the goal of assessing the feasibility, receptivity, and potential utility of the program for obese postpartum African American women; 1b) conduct a process evaluation to ensure high quality of program implementation and to obtain feedback from program participants and staff on their experiences with the program. Session observations, surveys, and interviews with program participants and staff will be conducted to provide data on the feasibility and receptivity of the program; and 2) conduct a preliminary evaluation of the intervention's effectiveness on weight loss, looking at 30 weeks postpartum change in weight and 12 month maintenance of weight loss, as compared to 6 week postpartum weight. Secondary outcomes will also be evaluated, including 30 week changes in behaviors as measured by change in physical activity, total daily caloric intake, and percent of total daily fat calories, and 12 month maintenance of these behaviors. A 2-armed randomized controlled trial will be undertaken for this evaluation, comparing the intervention participants (n=80) to control participants (n=80). This proposed study is both innovative and significant in its approach to reduce the racial disparity in obesity for African American women because it a) targets weight loss during postpartum, a time of significant weight loss need for obesity-vulnerable women and b) builds upon an existing culturally-tailored, empirically-supported clinical model, patient navigation (i.e. Birth Sisters), to support intervention involvement. PUBLIC HEALTH RELEVANCE: African American women are 60% more likely to be obese relative to white women in the US; in 2005-2006, 52.9% of non-Hispanic black women over 20 years of age were obese compared with 32.9% of non-Hispanic white women. Obesity risk for this African American population escalates in the postpartum period. This project seeks to reduce this disparity via a culturally-tailored intervention targeting postpartum weight retention in African American women, using an adaptation of the Diabetes Prevention Program as the intensive lifestyle component in addition to patient navigators to enhance compliance and provide social support and, if successful, this pilot study could become a model for an effort to reduce the disparity in the high prevalence of obesity and other co morbidities in African American women in the US.

描述（由申请人提供）：美国非裔美国女性的肥胖患病率高于大多数其他亚群体。 2005-2006年，20岁及以上的非裔美国女性中有52.9%患有肥胖症，而白人女性的这一比例为32.9%。除了肥胖差异之外，尽管许多非裔美国女性在美国尝试减肥，但她们的减肥效果并不如白人女性成功。需要采取针对文化的干预措施来解决肥胖和减肥成功方面的重要健康差异。产后期可能是对超重和肥胖的非洲裔美国女性进行行为干预的最佳机会；这个时期是女性特别关注临床护理并高度积极减肥的时期。我们当前的提案题为“减少服务不足的产后非裔美国女性的肥胖”，开发并试点了一项根据文化定制、基于临床的体重管理计划（以饮食和运动为重点），以减少产后非裔美国女性的肥胖。具体来说，该计划采用了多次有效的减肥计划，该计划在对抗糖耐量受损的患者中取得了成功，即糖尿病预防计划（DPP），并结合根据文化定制的患者导航策略，以支持肥胖产后非裔美国女性目标人群的临床护理利用和健康促进行为。同伴辅导员（出生姐妹）将充当患者导航员，支持项目参与和医疗保健获取。该项目的具体目标是： 1a) 试点测试一个根据文化量身定制、基于临床的减肥计划，旨在评估该计划对肥胖产后非洲裔美国女性的可行性、接受性和潜在效用； 1b) 进行过程评估，以确保计划实施的高质量，并获取计划参与者和工作人员对计划体验的反馈。将进行会议观察、调查以及对项目参与者和工作人员的访谈，以提供有关项目可行性和接受度的数据； 2) 对干预措施对减肥的有效性进行初步评估，观察产后 30 周的体重变化和 12 个月的减肥维持情况，并与产后 6 周的体重进行比较。还将评估次要结果，包括 30 周的行为变化（通过体力活动的变化、每日总热量摄入和每日总脂肪热量的百分比来衡量），以及这些行为的 12 个月维持情况。本次评估将进行一项双组随机对照试验，对干预参与者 (n=80) 与对照参与者 (n=80) 进行比较。这项拟议的研究在减少非裔美国女性肥胖种族差异的方法上既具有创新性，又具有重要意义，因为它a）针对产后减肥，这是肥胖易感女性需要大量减肥的时期；b）建立在现有的文化定制、经验支持的临床模型、患者导航（即出生姐妹）的基础上，以支持干预参与。 公共卫生相关性：在美国，非洲裔美国女性肥胖的可能性比白人女性高出 60%； 2005-2006年，20岁以上的非西班牙裔黑人女性肥胖率为52.9%，而非西班牙裔白人女性肥胖率为32.9%。非裔美国人的肥胖风险在产后会上升。该项目旨在通过针对非裔美国女性产后体重滞留的文化定制干预措施来减少这种差异，除了患者导航之外，将糖尿病预防计划作为强化生活方式的组成部分，以增强依从性并提供社会支持。如果成功，这项试点研究可能成为努力减少非裔美国女性肥胖和其他合并症高患病率差异的典范。 在美国。

项目成果

A Randomized Controlled Feasibility Trial in Behavioral Weight Management for Underserved Postpartum African American Women: The RENEW Study.

• DOI: 10.5888/pcd15.170400
• 发表时间: 2018-06-14
• 期刊: Preventing chronic disease
• 影响因子: 5.5
• 作者: Joshi PP;Quintiliani LM;McCarthy AC;Gilmore A;Mahesri M;Sullivan LM;Apovian CM
• 通讯作者: Apovian CM