Promoting Postpartum Weight Loss in Overweight Women

描述（由申请人提供）：超重的女性在怀孕期间保持体重的风险最大。产后体重潴留进一步加剧了这些女性一生中肥胖和相关疾病的风险。产后时期可能是促进减肥的特殊“教育时刻”。产后体重相关影响、风险认知和自尊的变化可能会增加女性对减肥的接受度和成功程度。然而，在缺乏正式干预的情况下，这些因素的产后变化也可能破坏体重减轻（例如，对儿童护理的额外需求可能会妨碍身体活动和适当的膳食计划）。因此，需要采取干预措施，利用产后自然发生的体重变化，鼓励增加体育活动和采用健康饮食，加速和/或增加有终身肥胖风险的妇女的产后体重减轻。此外，在何种程度上，产后是一个可教的时刻，可能修改正式干预的效力应进行实证调查。为此，建议进行一项两组5年随机干预试验。怀孕前超重或肥胖的初产妇在杜克诊所产下健康婴儿，是目标人群。将招募400名妇女，按种族（白人/其他种族和非裔美国人）分层，随机分为：最低护理：订阅12个月的新妈妈健康杂志，或积极母亲产后干预（AMP）：订阅杂志，10个积极妈妈体育锻炼课程，8个妈妈的营养课程，一辆运动婴儿车，6个电话咨询电话。主要目的是评估AMP是否可以：1：在干预后12个月（p.i.）促进更大的体重减轻。第2点：在产后1个月增加体力活动。第3点：在产后1个月减少热量摄入和脂肪摄入。第二个目的是评估参与干预和减肥是否在那些过渡到产后是一个“可教时刻”的妇女中效果最好。在怀孕32-36周时，将通过图表审查和电话来确定和筛选妇女的资格。参与者将在产后8周（干预前基线）和产后1、6和12个月进行调查。如果有效，AMP干预可以在农村和城市社区的卫生和社区中心推广。此外，延长随访将有助于评估干预对减肥和维持体重的长期效益。

DESCRIPTION (provided by applicant): Overweight women are at greatest risk of retaining weight gained during pregnancy. Postpartum weight retention further exacerbates these women's lifetime risk of obesity and related morbidities. The postpartum period may be a special "teachable moment" for promoting weight loss. Postpartum changes in weight-related affect, risk perceptions, and self esteem may increase women's receptivity to and success with weight loss. However, in the absence of formalized interventions, postpartum changes in these factors could also undermine weight loss (e.g., added demands of child care may hinder physical activity and proper meal planning). Thus interventions are needed that leverage naturally occurring postpartum weight changes to encourage increased physical activity and adoption of a healthy diet, to accelerate and/or increase postpartum weight loss among women at-risk for lifetime obesity. Moreover, the extent to which postpartum is a teachable moment that may modify the efficacy of formal intervention should be investigated empirically. To this end, proposed is a two-arm, five-year randomized intervention trial. Primiparous women, overweight or obese prior to pregnancy, who delivered healthy infants at a Duke clinic, are the target population. 400 women will be recruited, stratified by racial group (white/other and African American), and randomized to: MINIMAL CARE: a 12-month subscription to a new mothers health magazine, or the ACTIVE MOTHERS POSTPARTUM (AMP) INTERVENTION: the magazine subscription, 10 ACTIVMOMS physical activity sessions, 8 Mom's Time Out nutritional sessions, a sport stroller, and 6 telephone counseling calls. Primary aims are to evaluate whether AMP can: 1: promote greater weight loss 12-months post-intervention (p.i.). 2: increase physical activity at 1 month p.i. 3: lower calorie intake overall, and from fat, at 1-month p.i. The secondary aim is to assess whether participation in the intervention and weight loss is greatest among women for whom the transition to postpartum is a "teachable moment." Women will be identified and screened for eligibility by chart review and telephone at 32-36 weeks of pregnancy. Participants will be surveyed at 8 weeks postpartum (pre-intervention baseline) and at 1, 6 and 12 months p.i., If effective, the AMP intervention can be disseminated in health and community centers common in both rural and urban communities. In addition, extended follow-up will enable evaluation of long-term benefits of the intervention for weight loss and maintenance.