Behavioral Weight Management for Pregnant and Postpartum Women in the Military

 描述(由申请人提供)：一种常见的误解是，美国军事人员之所以健康、苗条和健康，是因为他们的军事生活方式(及其对健康促进的重视)，推断军队以某种方式“逃脱”了平民肥胖症的流行。相反，在美国现役女兵中，34%超重，6%肥胖。许多妇女(尤其是超重和肥胖妇女)在怀孕期间体重过度增加，而过度的妊娠体重增加是围产期并发症和产后体重滞留的重要风险因素。对于在美国军队服役的女性来说，产后体重保留尤其令人担忧，因为她们只需在产后6个月恢复健康标准，如果没有通过健康测试，她们可能会退伍。产后体重保持也是“军事准备”(或为国防快速动员的能力)的一个重要问题，这是国防部最重要的单一指标。鉴于过度孕期体重增加和产后体重滞留对健康的负面影响，超重对军事准备和军事生涯的阻碍，以及美国军队中缺乏关于妊娠期体重增加和产后体重减轻的研究，我们建议对现役妇女进行分步护理孕期体重增加干预和分步护理产后减肥干预，基于前瞻性强化生活方式干预，适应军人特有的生活方式和环境。我们将450名参与者随机分为3组：a)妊娠增重干预；b)产后减肥干预；或c)a 采用孕期增重和产后减肥相结合的干预措施，确定干预措施对孕期增重和产后6个月减重的效果。此外，我们将通过干预ARM检查医疗结果和医疗保健利用情况(来自电子病历)和体能测试数据(来自军事体能数据库)。我们还将收集与治疗结果相关的过程数据(例如，疗程参与、自我监测依从性、膳食替代依从性、体力活动)。我们将确定妊娠期体重增加干预、产后减肥干预或两种干预措施的组合在改善产后体重减轻、产妇健康和军事准备方面最有效。这些成果预计将产生重要的积极影响，因为干预措施(S)可以传播到整个美国军队，并纳入对怀孕/产后军人妇女的标准保健。

 DESCRIPTION (provided by applicant): A common misconception is that U.S. military personnel are fit, lean, and healthy because of the military lifestyle (and its emphasis on health promotion), inferring that the military has somehow "escaped" the civilian obesity epidemic. To the contrary, 34% of women actively serving in the U.S. military are overweight and 6% are obese. Many women (and particularly overweight and obese women) gain weight excessively while pregnant, and excessive gestational weight gain is a significant risk factor for perinatal complications and postpartum weight retention. Postpartum weight retention, in particular, is a significant concern for women serving in the United States military, as they only 6 months postpartum to return to fitness standards and they can be discharged if they fail their fitness test. Postpartum weight retention is also a significant concern for "military readiness" (or the ability to quickly mobilize for national defense), which is the single most important metric for th Department of Defense. Given the negative health implications of excessive gestational weight gain and postpartum weight retention, the impediment of excess weight on military readiness and military careers, and the dearth of research on gestational weight gain and postpartum weight loss in the United States military, we propose a stepped-care gestational weight gain intervention and a stepped-care postpartum weight loss intervention for active duty women, based on the Look AHEAD Intensive Lifestyle Intervention, that accommodates the lifestyle and environment that is unique to military personnel. We will randomize 450 participants to 1 of 3 arms: a) a gestational weight gain intervention); b) a postpartum weight loss intervention, or c) a combined gestational weight gain and postpartum weight loss intervention and determine the efficacy of the interventions on gestational weight gain as well as 6-month postpartum weight loss. In addition, we will examine medical outcomes and health care utilization (from the electronic medical record) and fitness test data (from the military fitness database) by intervention arm. We will also gather process data related to treatment outcome (e.g., session participation, self-monitoring adherence, meal replacement adherence, physical activity). We will determine whether a gestational weight gain intervention, a postpartum weight loss intervention, or a combination of the two interventions is most efficacious in improving postpartum weight loss, maternal health, and military readiness. These outcomes are expected to have an important positive impact because the intervention(s) could be disseminated the entire United States Military and integrated into standard health care for pregnant/postpartum military women.