A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program

Debra L. Haire-Joshu, Cynthia D. Schwarz, Sarah B. Peskoe, Elizabeth L. Budd, Ross C. Brownson, Corinne E. Joshu

Research output: Contribution to journalArticle

Abstract

Background: Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program. Methods: A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months). Results: When compared to the control group, BALANCE adolescents who were ≥ 12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking. Conclusion: Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity.

Original languageEnglish (US)
Article number88
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Volume12
Issue number1
DOIs
StatePublished - Jun 26 2015

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Postpartum Period
Randomized Controlled Trials
Obesity
Life Style
Snacks
Mothers
Child Development
Vegetables
Drinking
Walking
Fruit
Education
Weights and Measures
Control Groups
House Calls
Group Processes
Insurance Benefits
Fats
Organizations

Keywords

  • Adolescents
  • Behavioral interventions
  • Obesity prevention

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program. / Haire-Joshu, Debra L.; Schwarz, Cynthia D.; Peskoe, Sarah B.; Budd, Elizabeth L.; Brownson, Ross C.; Joshu, Corinne E.

In: International Journal of Behavioral Nutrition and Physical Activity, Vol. 12, No. 1, 88, 26.06.2015.

Research output: Contribution to journalArticle

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abstract = "Background: Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program. Methods: A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 {\%} underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months). Results: When compared to the control group, BALANCE adolescents who were ≥ 12 weeks postpartum were 89 {\%} more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking. Conclusion: Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity.",
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