After Baby Fitness Challenge: Moms’ Way to Better Health The Importance of Pre- and...

After Baby Fitness Challenge:Moms’ Way to Better Health

The Importance of

Pre- and Inter-Conceptional HealthJuly 18, 2012

Funding for this program was made possible in part by the HHS, HRSA, H59MC12788. The views expressed in written materials or publications and by speakers and moderators at HHS-sponsored conferences do not necessarily reflect the official policies of the Department of Health and Human Services; nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

After Baby Fitness Challenge:Moms’ Way to Better Health

Sandra C. Mobley, PhD, RN, Project Director/Co-Investigator (presenting)

Crystal E. Neal, MS, Research AssociateDeborah Young-Hyman, PhD, Evaluator/Co-Investigator

Marlo Vernon, MS, Research AssociateJodi Hudgins, MSN, RN, ECHS Clinical Services Coordinator

LaSonya Griffin, BSN, RN, ECHS Case ManagerJoeAnn McGhee, RN, ECHS Case Manager

Laura Tucker, BSN, RN, ECHS Case ManagerBetty Burnett, BA, ECHS Advocate

Judy Whitfield, ECHS AdvocateJeannie Hatfield, RD

Don Sutherland, PhD, ECHS Database AdministratorDebra Griffin, BA, Outreach CoordinatorMark Wilkinson, CPA, ECHS Accountant

Presentation Objectives• Review statistics related to obesity in the United States

• Connect goals and objectives of this research project to measures collected over the course of subject’s enrollment period.

• Describe the intervention components of the weight reduction program for postpartum women.

• Examine the results of the study to date.

• List the life style challenges and perceptions of rural women regarding their health and well-being.

• Identify ideas for furthering intervention work with regard to improving the weight, mental health and well-being of women of reproductive age.

Definitions

• BMI = body mass index / ht:wt• BMI between 25 and 29.9 = overweight• BMI of 30 or higher = obese• BMI of 16 or less = anorexic

• waist circumference --abdominal fat is a predictor of risk for obesity-related diseases

http://www.cdc.gov/obesity/adult/defining.html

Percent of Obese (BMI > 30) in U.S. Adults

http://www.cdc.gov/obesity/data/adult.html

http://childhealthdata.org/browse/rankings/maps?s=31

2009 Age-Adjusted Estimates of the Percentageof Adults Who Are Obese in Georgia

http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?mode=OBS

Enterprise Community Healthy Start

Research DesignDesign•Comparative effectiveness research•McDuffie –intervention/ Burke –controlEnrollment criteria•ECHS clients•At least 18 years of age•Postpartum 6 weeks-6 months•BMI > 25

Goals and Objectives of ResearchGoal: Reduce the Body Mass Index (BMI)By 7/31/12:• Objective 1: 90% of participants will increase overall level of

physical activity (PA), regardless of type of PA, as measured by PA diary, to 1 hour twice per week.

• Objective 2: 90% of participants will attend monthly group nutrition sessions at a minimum of 75% of sessions annually.

• Objective 3: 90% of participants will increase intake of fruits and vegetables from baseline, based on two 24-hour dietary recalls.

• Objective 4: 90% of participants will increase nutrition knowledge from baseline, based on a test of general nutrition knowledge.

Goals and Objectives of ResearchGoal: Improve depression scores on either instrument at each

repeated measureBy 7/31/12:• Objective 1: 60% of participants will reduce levels of depression,

based on changes in Edinburgh Postnatal Depression Scale (EPDS) and/or Beck Depression Inventory (BDI) scores at 6 and 12 months postpartum.

• Objective 2: 60% of participants will improve quality of well-being, based on SF-12v2 Health and Well-Being Survey (SF-12) scores at 6 and 12 months postpartum.

• Objective 3: 60% of participants who have positive depression screens will complete referrals for mental health counseling.

Research Protocol• ECHS clients sign Informed Consent Form• Baseline measures are completed• Participants receive a free gym membership• 2 nutrition classes per month• 120 minutes of exercise per week• Weekly weight and waist measurements• 3, 6, 9, and 12 month assessments at ECHS

office or client’s home• Participants may be in program 1 year

Interventions• Case Management (intervention and control groups)• Intervention Group Only

– Nutrition Education (intervention group only)• Classes led/developed by RD or Research Associate• Open to children and family members• Held 4 times per month

– Exercise• Y membership (child care, card scanning capability)• Classes led by Research Associate

– Incentives• Y membership, free pedometer, WalMart gift card

Nutrition Class Topics• Food Guide Pyramid (which became choose my plate 2011)• Fat- substituting fat in cooking• Calories and maintaining food records• Meal patterns and sample menus• Sodium• Food Safety• Nutrition for Breastfeeding Moms• Dairy Foods and Importance of Calcium• Fiber and Whole Grains• Nutrition Facts Label• Lean protein foods• Eating healthy when dining out• Fruits and Veggies- why is variety important?• Obesity, hypertension and diabetes relationship• Being a role model for your children• Eating better on a budget / Wise shopping

Flow ChartAssessed for eligiblitiy

(n = 114)

Eligibles

Dropped out of ECHS prior to3 months, n=3

En

tro

llme

nt

Allo

cati

on

An

alys

is

Control Group(Burke County)

n = 42

Baseline and 3monthsn=39

Baseline, 3 and 6monthsn=39

4239

Criteria1. At least 18 years of age2. Postpartum ECHS client3. BMI >=25

Treatment Group(McDuffie County)

n = 72


3939

Baseline, 3, 6,and 9 months

n=37


39

1. Dropped out prior to 3 months, n=92. <3 months in the program, n=5

Baseline and 3monthsn=58

Baseline, 3 and 6monthsn=33

3322


58

15

Baseline, 3, 6,and 9 months

n=22


22

72

3358

Baseline, 3, 6, 9,and 12 months

n=37


37

Baseline, 3, 6, 9,and 12 months

n=15


Subject Characteristics (@3months)

All Subjects (n = 100)

Intervention (n = 58)

Control (n = 42)

Mean ± SD Range Mean ± SD Range Mean ± SD Range

Age 26.0 ± 5.9 18 - 43 24.8 ± 4.7 18 – 40 27.7± 6.81 19 - 43

# of Risks 3.2 ± 2.0 0 - 12 3.1 ± 1.9 0 – 9 3.4 ± 2.1 0 – 12

Education 11.9 ± 1.7 7 – 16 11.7 ± 1.6 7 – 15 12.1 ± 1.9 8 – 16

Gravida 2.7 ± 1.9 1 – 9 2.6 ± 1.8 1 – 9 2.9 ± 2.0 1 – 7

1: Between groups, t = 2.4, p <.02

Subject Characteristics All Subjects

(n = 100)Intervention

(n=58)Control(n = 42)

Race African American 91% 90% 93%

Method of Feeding at Baseline1 Breast 13% 2% 27%Bottle 72% 82% 61%Both 15% 17% 12%

Marital Status Single 82% 83% 81%Married 16% 15% 17%Divorced 2% 2% 2%

Father Involvement None 21% 28% 12%Visits Occasionally 17% 15% 19%Visits Weekly 9% 7% 12%Visits Daily 19% 21% 17%Lives in Home 34% 29% 41%

1 : Between groups, X2 = 13.2, p<.01

Healthy Weight Outcomes

Physical Activity Levels

Physical Activity Recall

Physical Activity

Baseline

(n = 153 days by 51 women)

3 months (n = 66 days by 22

women)

6 months (n=60 days by 20

women)

9 months (n= 39 days by 13

women)

12 months (n = 48 days by 16

women)

Mean ± SD Range Mean ± SD Range Mean ± SD Range Mean ± SD Range Mean ± SD Range

Sleep 9.4 ± 2.3 4.5 – 17.7 9.7 ± 2.4 3.8 – 13.0 10.2 ± 1.8 6.5 – 12.3 10.9 ± 2.4 7.0 – 16.0 10.7 ± 2.1 6.0 – 14.3

Work 1.4 ±2.8 0 – 12.0 2.8 ± 3.6 0 – 9 2.6 ± 3.7 0 – 8.7 2.0 ± 3.5 0 – 9.0 2.5 ± 3.6 0 – 10.3

Household 1.4± 1.2 0 – 4.38 2.3 ± 2.1 0 - 7 1.4 ± 1.5 0 – 5.5 1.1 ± 1.2 0 – 3.5 1.9 ± 1.41 0 – 4.2

Childcare 2.9 ± 2.0 0 – 11.0 2.9 ± 2.2 .5 – 11.0 2.1 ± 1.5 .5 – 6.5 2.4 ± 1.5 .5 – 5.2 1.7 ± 1.02 0 – 3.4

Exercise, Average hrs/day .67 ± 1.0 0 – 4.0 .7 ± 1.2 0 – 5.5 1.2 ± 1.43 0 – 5.0 .87 ± .96 0 – 3.0 .4 ± .74 0 – 2.0

Moderate Hours .59 ± 1.4 0– 8.0 1.1 ± 2.8 0 – 8.0 .65 ± 1.1 0 – 3.5 .67 ± 1.7 0 – 6.0 .4 ± .9 0 – 3.5

1 = Baseline ∆ 12m, t = 2.101, p<.06 2 = Baseline ∆ 12m, t = 2.294, p<.03 3 = Baseline ∆ 6m, t = -2.14, p<.05, 4 = 6m ∆ 12m, t = 2.1, p<.05

Physical Activity

Light Activities Reported at Baseline Rank Activity 1 child care (general) 2 watching tv or movie 3 hanging around 4 transportation 5 eating a meal 6 occupation, light standing 7 Self-care 8 reading 9 shopping 10 reclining with baby

Light Activities Reported at 6 months Rank Activity

1 Hanging around 2 Watching tv/movie 3 Child care (general) 4 Occupation, light standing 5 Transportation 6 Household chores 7 Playing with baby/children 8 Eating 9 Cooking

10 Shopping

Light Activities Reported at 12 months Rank Activity

1 Watching tv or movies 2 hanging around 3 Occupation, light standing 4 child care (general) 5 Household chores 6 Self-care 7 cooking 8 transportation 9 Shopping

10 Eating

Light Activities Reported

Physical ActivityModerate Activities Reported

Mod/VigActivities Reported at Baseline Rank Activity

1 Occupation, walking/patient care 2 Walking briskly 3 Carrying child upstairs 4 Calisthenics 5 Basketball 6 Yard work 7 Aerobics 8 Childcare, general 9 Jogging/Running

10 playing with baby/children

Mod/Vig Activities Reported at 6 months Rank Activity

1 Bowling 2 Yard work 3 Dancing 4 Aerobics

Mod/Vig Activities Reported at 12 months Rank Activity

1 Soccer 2 Occupation, walking/patient care 3 Football 4 Aerobics 5 Dancing 6 Yard Work

Physical ActivityExercise Activities Reported

Exercise Activities Frequently Reported 6m

Rank activityname

1 walking slowly

2 walking pushing stroller 15-30 lbs

3 walking pushing stroller (1-15lbs)

4 dancing (social, recreational)

5 bowling

6 aerobics, aerobic dance 7 dancing (ballet, jazz)

Exercise Activities Frequently Reported Baseline

Rank activityname 1 walking slowly 2 dancing (social, recreational) 3 walking briskly 4 walking pushing stroller (1-15lbs) 5 calisthenics 6 basketball 7 aerobics, aerobic dance 8 jogging/running 9 ice/roller skating

Exercise Activities Frequently Reported 12m

Rank activityname 1 soccer 2 aerobics, aerobic dance 3 walking pushing stroller (1-15lbs) 4 walking slowly 5 football 6 dancing (social, recreational)

Quick List• Outline of the meal

– Enter meal time, name and location– List foods and beverages– Enter exactly as reported

• Prompt questions– “After midnight, what was the first time you had something to eat or

drink?”– “What did you have at that time?”– “Did you have anything else at that time?” Repeat until subject

answers “no.”

• Review for omissions

Details

• Provides level of food detail required for research– Chicken drumstick– Skin eaten– Fried, breaded- coating eaten– Home prepared– Pan fried– In Mazola corn oil– With regular salt

Nutrition Data System for Research

• Most accurate and comprehensive nutrient calculation software available for research

• Commonly referred to as NDS-R

• Uses the multi-pass approach for conducting dietary recalls

NDS-R Program

• Uses the multi-pass approach– The participant “recalls”

• Make a brief list• Review for omissions• Obtain details• Review the details

– The interviewer becomes actively involved in the participant’s “recollection”

– Reduces the incidence of under-reporting

Comparisons of Nutrient Intake

Baseline 6 months 12 months

Recommended Intake1

Mean ± SD

Range Mean % of

EnergyMean ± SD

Range Mean % of

EnergyMean ± SD

Range Mean % of

EnergyMin Max Min Max Min Max

Energy (kCal) 1658.5 ± 646.1 184.3 3224.6

1366.6 ± 864.8*

450.9 2468.1

1281.5 ± 424.8@

621 2142.5

Fat (g) 20-35% 65.9 ± 33.2 7.5 164.6 35.5 54.9± 21.9+ 20.2 116.2 36.3 55.5 – 21.8++ 26.9 98.0 36.7

Carbohydrate (g) 130g (45-65%) 207.5 ± 91.5 21.0 476.0 49.8 167.7 ± 88.3 41.5 403.0 47.4 141.5 ± 42.8 77.5 211.8 48.0

Protein (g) 46g (10-35%) 60.8 ± 26.7 7.74 127.0 15.3 54.8 ± 18.0 24.8 88.5 16.6 55.8 ± 27.2 9.6 115.5 16.2

Trans Fatty Acids (g)

5.2g ± 3.6 .00 18.7 3.6 ± 2.8× .0 8.6 2.4 ± 2.4xx 0.0 – 6.6

Monounsaturated Fatty Acids (g)

10% 25.5 ± 13.3 3.01 68.7 13.7 21.8 ± 8.5 8.3 42.8 14.4 22.2 ± 9.0 12.2 41.5 14.7

Polyunsaturated Fatty Acids (g)

10% 12.g ± 7.2 2.1 31.7 6.7 10.2 ± 6.9 3.5 30.9 6.9 10.3 ± 4.0 4.1 17.9 6.9

Dietary Fiber (g) 20-30g 10.7 ± 10.1 1.9 74.8

6.7 ± 3.6b 1.5 15.7

7.5 ± 3.2bb 2.6 13.22

Sodium (mg) <2300mg 2943.5 ± 1330.4 538.8 7199.5

2526.5 ± 714.0c

1028.5 4066.6

2534.2 ± 1089.8d

732.7 4521.2

Baseline ∆ 6m Baseline ∆ 12m

* t = -2.25, p<.03 ** t = -3.54, p<.003

+ t = -2.12, p<.05 ++ t = -3.82, p<.01x t = -2.17, p<.04 xx t = -3.65, p<.01b t = -2.85, p<.01 bb t = -2.08, p<.05c t = -2.39, p<.03 d t = -2.30, p<.04

1 Dietary Guidelines for Americans, 2010, USDA

Nutrition Knowledge ItemsWhole milk is a good source of:a. vitamin K b. vitamin A c. vitamin E d. fiber e. vitamin D Canned soups, ham and pickles are very high in:a. thiamin (B1) b. fiber c. zinc d. vitamin E e. sodium

Which food contains the greatest amount of fiber per cup? a. brownies b. corn flakes c. iceberg lettuce d. kidney beans e. pasta

Not enough _________ in the diet has been linked to birth defects involving the brain and spine (spina bifida). a. calcium b. folic acid c. iron d. vitamin A e. vitamin C Which food below does NOT contain carbohydrates?a. apple b. coke c. hamburger meat d. milk e. peas

Nutrition Knowledge Nutrition Knowledge Test, Max Score = 100

Baseline

6 months (Intervention Group only)

12 months

BMI n Mean ± SD Range

n Mean ± SD Range

n Mean ± SD Range

Min Max Min Max Min Max

All Subjects 95 48.8 ± 13.7 20 84 28 53.4 ± 12.2 24 72

Intervention 53 48.7 ± 11.5 24 76 18 50.67 ± 12.7 32 80 16 53.5± 14.4 24 72

Control 42 49.05 ± 16.2 20 64 12 53.0 ± 8.5 40 64

*Not significantly different between groups, within groups

Intake of Fruits and Vegetables


Intervention Group

n Mean ±

SD

Range n

Mean ± SD

Range n

Mean ± SD

Range

Min Max Min Max Min Max

Average Daily Fruit and Vegetable

Intake

53 .94 ± .8 0 3.65 20 .64 ± .5 0 1.52 15 .81 ± .7 0 2.43

Correlation with Nutrition Knowledge

Score

.368** .531* -.203

*p<.05, ** p<.01

Among women who remain in the intervention to 12 mos., FV intake and knowledge appear to remain the

same.

Although average knowledge appears to slightly increase over the course of the intervention, increase in

knowledge is not sufficient to change behavior.

Healthy Weight Process MeasureNutrition Class Attendance

• At 3 months in the program, 6/40 or 15.0% had attended 75% of classes.



• At 12 months in the program, 3/15 or 20.0 % had attended 75% of classes.

Healthy Weight — Reduce BMI Baseline 6 months 12 months

Range Range Range BMI n Mean ± SD

Min Max n Mean ± SD


Min Max

All Subjects 100 35.02 ± 7.5*+ 25.0 57.2 53 35.2 ± 7.8* 24.7 57.4 36 35.9 ± 8.2+ 24.3 60.7





Min Max

All Subjects 100 35.02 ± 7.5*+ 25.0 57.2 53 35.2 ± 7.8* 24.7 57.4 36 35.9 ± 8.2+ 24.3 60.7

Intervention 58 35.5 ± 7.4 25.0 57.2 23 36.5 ± 7.6 25.6 57.4 15 35.1 ± 6.4 24.8 48.1





Min Max

All Subjects 100 35.02 ± 7.5*+ 25.0 57.2 53 35.2 ± 7.8* 24.7 57.4 36 35.9 ± 8.2+ 24.3 60.7

Intervention 58 35.5 ± 7.4 25.0 57.2 23 36.5 ± 7.6 25.6 57.4 15 35.1 ± 6.4 24.8 48.1

Control 42 34.3 ± 7.6#@ 25.0 56.5 30 34.3 ± 7.9#$ 24.7 57.4 21 36.4 ± 9.4@$ 24.3 60.7

Among all Subjects: * Baseline ∆ 6m, t = -2.7, p<.001 + Baseline ∆ 12m, t = -2.4, p<.02 Within the Control Group: # Baseline ∆ 6m, t = -2.0, p<.05 @ Baseline ∆ 12m, t = -3.2, p<.004 $ 6m ∆ 12m, t = -2.7, p<.01 Not significantly different between groups

Mental Wellness Outcomes

BDI (Positive >=13) ________________________________________________________________________________________________________________ [0] I do not feel sad [0] I am not discouraged about my future [1] f eel sad much of the time [1] I am more discouraged about my future than I used to be [2] I am sad all of the time [2] I do not expect things to work out f or me [3] I am so sad or unhappy I can’t stand it [3] I f eel my future is hopeless and will only get worse ________________________________________________________________________________________________________________ [0] I do not feel like a f ailure [0] I get as much pleasure f rom things I enjoy as I ever did [1] I have failed more than I should have [1] I don’t enjoy things as much as I used to [2] As I look back, I see a lot of f ailures [2] I get very little pleasure f rom the things I used to enjoy [3] I f eel I am a total f ailure as a person [3] I can’t get any pleasure f rom the things I used to enjoy ________________________________________________________________________________________________________________ [0] I don’t f eel particularly guilty [0] I don’t f eel I ’m being punished [1] I f eel guilty over many things I ’ve done [1] I f eel I may be punished [2] I f eel quite guilty most of the time [2] I expect to be punished [3] I f eel guilty all of the time [3] I f eel I am being punished ________________________________________________________________________________________________________________ [0] I f eel the same about myself as ever [0] I don’t criticize or blame myself more than usual [1] I have lost confidence in myself [1] I am more critical of myself than I used to be [2] I am disappointed in myself [2] I criticize myself f or all my f aults [3] I dislike myself [3] I blame myself f or everything bad that happens ________________________________________________________________________________________________________________ [0] I don’t have any thoughts of killing myself [0] I don’t cry anymore than I used to [1] I have thoughts of killing myself, but I would [1] I cry more than I used to not carry them out [2] I cry over every little thing [2] I would like to kill myself [3] I f eel like crying, but I can’t [3] I would kill myself if I had the chance ________________________________________________________________________________________________________________ [0] I am no more restless or wound up than usual [0] I make decisions about as well as usual [1] I f eel more restless or wound up than usual [1] I find it more diffi cult to make decisions than usual [2] I am so restless or agitated it’s hard to stay still [2] I have much greater diffi culty in making decisions than I used to [3] I am so restless or agitated that I have to keep [3] I have trouble making any decisions moving or doing something ________________________________________________________________________________________________________________ [0] I do not f eel I am worthless [0] I have as much energy as ever [1] I don’t consider myself as worthwhile and useful as I used to [1] I have less energy than I used to have [2] I f eel more worthless as compared to other people [2] I don’t have enough energy to do very much [3] I f eel utterly worthless [3] I don’t have enough energy to do anything ________________________________________________________________________________________________________________ [0] I have not experienced any change in my sleeping pattern [0] I have not experienced any change in my appetite (eating) [1] I sleep somewhat more than usual [1] My appetite is somewhat less than usual [1] I sleep somewhat less than usual [1] My appetite is somewhat more than usual [2] I sleep a lot more than usual [2] My appetite is much less than before [2] I sleep a lot less than usual [2] My appetite is much more than before [3] I sleep most of the day [3] I have no appetite at all [3] I wake up 1-2 hours early and can’t go back to sleep [3] I crave f ood all of the time ________________________________________________________________________________________________________________ [0] I am no more irritable (cranky) than usual [0] I can concentrate as well as ever [1] I am more irritable than usual [1] I can’t concentrate as well as usual [3] I am much more irritable than usual [2] I t’s very hard to keep my mind on anything f or very long [3] I am irritable all the time [3] I find I can’t concentrate on anything ________________________________________________________________________________________________________________ [0] I am no more tired or f atigued than usual [0] I have not noticed any recent change in my interest in sex [1] I get tired more easily than usual [1] I am less interested in sex than I used to be [2] I am too tired to do a lot of things I used to do [2] I am much less interested in sex now [3] I am too tired to do most of the things I used to do [3] I have lost interest in sex completely ________________________________________________________________________________________________________________ [0] I have not lost interest in other people or activities [ ] I wish I was still pregnant This question is not scored [1] I am less interested in other people or things than before [ ] I enjoy having my baby more than I enjoyed my pregnancy [2] I have lost most of my interest in other people or things [ ] Having a baby is harder than I thought it would be [3] I t’s hard to get interested in anything [ ] I hope I never have another baby

Edinburgh (Positive >=10) I have been able to laugh and see the funny side of things:

[0] as much as I always could [1] not quite so much now [2] defi nitely not so much now [3] not at all [ ] I don’t understand this question I have looked f orward with enjoyment to things:

[0] as much as I ever did [1] rather less than I used to [2] defi nitely less than I used to [3] hardly at all [ ] I don’t understand this question I have blamed myself unnecessarily when things went wrong:

[3] yes, most of the time [2] yes, some of the time [1] not very of ten [0] no, never [ ] I don’t understand this question I have been anxious or worried for no good reason:

[0] no, never [1] hardly ever [2] yes, sometimes [3] yes, very of ten [ ] I don’t understand this question I have felt scared or panicky f or no very good reason:

[3] yes, quite a lot [2] yes, sometimes [1] no, not much [0] no, not at all [ ] I don’t understand this question Things have been making me f eel overwhelmed:

[3] most of the time I haven’t been able to cope at all [2] sometimes I haven’t coped as well as usual [1] rarely, most of the time I have coped quite well [0] never, I have been coping as well as ever [ ] I don’t understand this question I have been so unhappy I have had diffi culty sleeping:

[3] yes, most of the time [2] yes, sometimes [1] not very of ten [0] never [ ] I don’t understand this question I have felt sad or miserable:

[3] yes, most of the time [2] yes, quite of ten [1] not very of ten [0] never [ ] I don’t understand this question I have been so unhappy that I have been crying:

[3] yes, most of the time [2] yes, quite of ten [1] only occasionally [0] never [ ] I don’t understand this question The thought of hurting myself has occurred to me:

[3] yes, quite often [2] sometimes [1] hardly ever [0] never [ ] I don’t understand this question

Mental Wellness OutcomesDepression Scores

Significant Differences between groups

BDI 12m N Mean ± SD t p

Intervention 15 4.75 ± 1.22.1 .05

Control 17 9.0 ± 2.2

EPDS 12m N Mean ± SD t p

Intervention 15 3.1 ± 3.12.2 .03

Control 17 6.6 ± 5.7

Beck Depression Inventory, Clinical cutoff, ≥13

Edinburgh Postnatal Depression Survey, Clinical cutoff, ≥ 10

Mental Wellness OutcomesQuality of Well-Being

Sf-12 Scale Scores

Baseline (n = 51) 6 months (n = 20) 12 months (n = 15)

Normalized Mean ± SD Range %

< 30th

% <

40th

% >

50th Mean ± SD

Range % <

30th

% <

40th

% >

50th

Mean ± SD

Range % <

30th

% <

40th

% >

50th Min Max Min Max Min Max

Physical Component

Summary 46.0 ± 7.9 27 61 4% 22% 28% 50.2 ± 6.41 40.1 59.3 0% 0% 53% 48.4 ±6.2 35.7 54.8 0% 13% 47%

Mental Component

Summary 46.7 ± 13.1 17 65 14% 31% 53% 46.9 ± 11.7 19.4 62.2 5 26% 47% 53.4 ±6.72 39.9 62.3 0% 7% 66%

Role limitations due to Physical

problems 44.3 ± 9.8 20.3 57.2 52.3 ±8.03 29.5 57.2 50.1 ±8.5 34.1 57.2

Vitality 48.9 ± 9.6 27.6 67.9 48.8 – 10.8 27.6 67.9 53.1 ±9.24 37.7 67.9

Social Functioning 47.4 ± 11.8 16.2 56.6 45.5 ± 13.55 26.3 56.6 52.5 ±7.4 36.4 56.6

1 Baseline ∆ 6m, t = -2.3, p<.03 2 6m ∆ 12m, t = -2.2, p<.05 3 Baseline ∆ 6m, t = -4.5, p<.001 4 Baseline ∆ 12m, t = -2.0, p<.07 5 6m ∆ 12m, t = -2.4, p<.03

Mental Wellness Process MeasureCompleted Mental Health Referrals

Of the 72 enrolled subjects, 68 had depression screens. Of these 68, 21 (30.9%) had positive depression screens. Of these 21, 7 (33.3%) were referred for mental health counseling. Of these 7 who were referred, none completed a mental health referral.

Summary

• The program reached target population• Limitation-many did not complete the study• Population very challenged (quality of well-being

survey)– Depressed but don’t think they are (inaccurate

perceptions of self)– Sedentary but that’s their lifestyle– Diminished quality of life but see their life as

normal

Summary• Women in the intervention group did not have an increase

in BMI over the 12-month intervention course, in comparison to the control group where a significant increase in BMI occurred from baseline to the 12-month evaluation (p<0.004)

• Regarding depression screening, the intervention group had a significant improvement from baseline to 12 months, whereas the control group did not, resulting in a significant difference in depression scores as measured by the EPDS (p<0.03) and the BDI (p<0.05) between groups at 12 months.

Summary

• In the intervention group only, the physical well-being score improved significantly from baseline to 6 months (p<0.03) and the mental wellness scale improved significantly from 6 to 12 months (p<0.05).

• Caloric intake in the intervention group decreased significantly at both 6 and 12 months from baseline. Intervention women decreased caloric intake on average 277 calories per day (p<0.003). This decrease stabilized their weight; their exercise did not.

• Exercise (walking, aerobics, dancing) increased in the intervention group between baseline and 6 months (p<0.05) and decreased back to baseline between 6 and 12 months.

Summary• Household activities increased significantly in the intervention

group from baseline to 12 months (p<0.05).• Amount of time spent in work-based physical activity did not

change significantly in the intervention group at any time period.

• However, time spent in child-care activities decreased significantly in the intervention group between baseline and 12 months (p<0.02).

• Despite a decrease in caloric intake, mothers’ decreased physical activity in the intervention group resulted in no overall change in BMI. In contrast, BMI in the control group significantly increased (p<0.004).

Implications for future research• Service project provides a platform for natural

experiment/study– We feel we are getting real data from the subjects, b/c we

have relationships with them• Evaluation should be built into service projects b/c more cost

effective, community based, and generalizable • Consider for intervention modifications:

– Include children and family members in NE and PA– Include best friend as buddy/partner/coach

• Interventions may lead to primary prevention of obesity among children of high risk women

Implications for practice

• Program design– Include children and family members in NE and PA– Include best friend as buddy/partner/coach– If community environment permits, include walking activities in

conjunction with food shopping or stroller groups– Use texting and Facebook for communication

• Challenges– Participant transportation– Participants’ work schedules– Lack of self-motivation from participants– Lack of daily structure

Lessons learned

– Designated staff for coaching specifically focused on nutrition and exercise is necessary

– Sustaining motivation seems to be a significant barrier to intervention success.

– An obesigenic lifestyle appears to be entrenched in this population and multi-generational.

Conclusions

• We reached the intended women.• We successfully implemented a program with

few community resources and small budget.• Approach and method

– a) proved to be efficacious and – b) impacts the rising tide of obesity and obesity

related diseases among the highest risk women.

Thank you!

[email protected]

mailto:[email protected]

After Baby Fitness Challenge: Moms’ Way to Better Health The Importance of Pre- and...

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