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体重增加的风险最大。产后体重滞留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。产后期可能是促进减肥的特殊“可教时刻”。产后在与体重相关的情绪、风险认知和自尊方面的变化可能会增加女性对减肥的接受度和成功程度。然而，在没有正式干预措施的情况下，产后这些因素的变化也可能破坏减肥(例如，增加儿童保育需求可能会阻碍体力活动和适当的饮食计划)。因此，需要采取干预措施，利用自然发生的产后体重变化来鼓励增加体力活动和采用健康饮食，以加速和/或增加有终身肥胖风险的妇女的产后体重减轻。此外，在多大程度上产后是一个可教的时刻，可以改变正式干预的效果，应该进行实证研究。为此，提出了一项为期五年的双臂随机干预试验。在杜克大学诊所生下健康婴儿的初产妇女，怀孕前超重或肥胖，是目标人群。400名妇女将被招募，按种族分组(白人/其他人和非裔美国人)，并随机分为：最低限度的护理：订阅一本新的母亲健康杂志12个月，或积极母亲产后干预(AMP)：杂志订阅，10次ACTIVMOMS体育活动，8次母亲营养暂停会议，一个运动婴儿车，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个月促进更大程度的减肥(P.I.)。2：在P.I.的1个月时增加体力活动3：在1个月的P.I.中，总体上较低的卡路里摄入量，从脂肪中摄取第二个目标是评估参与干预和减肥的女性是否在产后过渡是一个“可教的时刻”。在怀孕32-36周时，将通过图表审查和电话对妇女进行鉴定和资格筛选。参与者将在产后8周(干预前基线)以及在1、6和12个月的P.I.进行调查，如果有效，AMP干预可以在农村和城市社区常见的健康和社区中心传播。此外，延长的随访将使评估减肥和维持体重的干预措施的长期益处成为可能。

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.