Reducing Obesity in Underserved Postpartum African American Women

描述(由申请者提供)：美国非裔美国女性的肥胖率高于大多数其他亚群。2005-2006年，20岁及以上的非裔美国女性中有52.9%的人肥胖，而白人女性的这一比例为32.9%。除了肥胖差距，尽管许多非裔美国女性在美国尝试减肥，但她们在减肥方面不如白人女性成功。有必要采取有文化针对性的干预措施，以解决肥胖和减肥成功之间的这一重要的健康差距。产后期可能是接触超重和肥胖的非裔美国女性进行行为干预的最佳时机；这段时间是女性尤其与临床护理联系在一起的时期，也是女性减肥的强烈动力。我们目前的提案名为《在服务不足的产后非裔美国女性中减少肥胖》，开发并试行了一项文化定制、以诊所为基础的体重管理计划(以饮食和锻炼为重点)，以减少产后非裔美国女性的肥胖。具体地说，该计划采用了多疗程有效减肥计划，展示了在与糖耐量受损抗争的患者中取得成功的糖尿病预防计划(DPP)，并结合文化定制的患者导航策略，支持我们的目标人群--产后肥胖的非裔美国女性--的临床护理利用和健康促进行为。同伴辅导员(生育姐妹)将充当患者导航员，支持项目参与和卫生保健准入。该项目的具体目标是：1a)试行一项以文化为基础、以诊所为基础的减肥计划，目的是评估该计划对产后肥胖的非裔美国女性的可行性、接受性和潜在效用；1b)进行过程评估，以确保高质量的计划实施，并从计划参与者和工作人员那里获得对该计划经验的反馈。将对计划参与者和工作人员进行会议观察、调查和访谈，以提供有关该计划的可行性和接受性的数据；以及2)对干预措施在减肥方面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，与6周的产后体重进行比较。还将评估次要结果，包括30周的行为变化，通过体力活动、每日总卡路里摄入量和总脂肪卡路里的百分比来衡量，以及这些行为的12个月保持。本次评估将采用双臂随机对照试验，将干预组(n=80)和对照组(n=80)进行比较。这项拟议的研究在减少非裔美国女性肥胖方面的种族差异方面既有创新又有意义，因为它a)以产后减肥为目标，产后是肥胖易感女性显著减肥的时期，b)建立在现有的文化定制和经验支持的临床模型基础上，患者导航(即生育姐妹)，以支持干预参与。 公共卫生相关性：在美国，非裔美国女性肥胖的可能性比白人女性高60%；2005-2006年，20岁以上的非西班牙裔黑人女性肥胖的比例为52.9%，而非西班牙裔白人女性的肥胖比例为32.9%。这些非裔美国人的肥胖风险在产后期间会上升。该项目旨在通过针对非裔美国女性产后体重保留的文化定制干预措施来缩小这种差异，将糖尿病预防计划的适应作为密集生活方式的组成部分，此外还使用患者导航器来提高遵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美国非裔美国女性肥胖症和其他并存疾病高患病率差异的模式。

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.