Promoting Postpartum Weight Loss in Overweight Women

描述（由申请人提供）：超重妇女在怀孕期间保持体重增加的风险最大。产后体重保持进一步加剧了这些妇女一生中患肥胖症和相关疾病的风险。产后时期可能是促进减肥的一个特殊的“可教时刻”。产后与体重相关的情感、风险认知和自尊的变化可能会增加女性对减肥的接受性和成功率。 然而，在没有正式干预的情况下，这些因素的产后变化也可能破坏体重减轻（例如，额外的儿童保育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，利用自然发生的产后体重变化，鼓励增加体力活动和采用健康饮食，以加速和/或增加终身肥胖风险妇女的产后体重减轻。此外，产后在多大程度上是一个可教的时刻，可能会修改正式干预的效果，应进行实证调查。为此，提出了一项为期五年的两组随机干预试验。在杜克诊所分娩健康婴儿的初产妇女，怀孕前超重或肥胖，是目标人群。将招募400名女性，按种族组（白色/其他和非洲裔美国人）分层，并随机分配至：MINIMAL CARE：新妈妈健康杂志12个月订阅，或Active MOTHERS POSTPARTUM（AMP）干预：杂志订阅，10次ACTIVMOMS体力活动课程，8次Mom's Time Out营养课程，运动推车和6次电话咨询。主要目的是评估AMP是否可以：1：促进干预后12个月（p.i.）的体重减轻。2：在注射后1个月增加体力活动3：在1个月的p.i.时，总体卡路里摄入量较低，来自脂肪。次要目的是评估对于产后过渡为“可教导时刻”的女性来说，参与干预和减肥的程度是否最高。“妇女将在怀孕32-36周时通过图表审查和电话进行身份鉴定和资格筛选。参与者将在产后8周（干预前基线）和感染后1、6和12个月接受调查，如果有效，AMP干预措施可以在农村和城市社区常见的卫生和社区中心传播。此外，延长随访将能够评估干预措施对减肥和维持体重的长期益处。

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.