Community-based Obesity Treatment in African American Women After Childbirth

Study Overview
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Brief Summary
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The purpose of this study is to determine the effect of the community-based obesity treatment (PP), compared to usual care (UC), on changes in maternal weight over 12 months.

Detailed Description
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The investigators propose to randomize overweight or obese, African American postpartum WIC participants (n=300) to either usual care (UC) or a community-based obesity treatment (PP) arm. Recruitment will occur in 6 of Philadelphia Women Infants Children's (WIC) clinic sites in the early postpartum period (≤ 6 months after birth). Once enrolled, participants will complete surveys and baseline assessments of their weight, waist circumference, blood pressure, and height at The Center for Obesity Research and Education (CORE). Participants will also have a fasting blood sample taken. Study staff will administer a number of questionnaires assessing demographics, psychosocial factors, contextual factors, and behavioral targets via questionnaires prior to randomization. Participants will then be randomized to the 12-month postpartum weight loss intervention (PP) or usual care (UC). Additional assessments will be conducted at 6 and 12 months post baseline. The PP arm includes expanded obesogenic behavior change goals, tailored skills training materials, interactive self-monitoring text messages, video testimonials, and interpersonal counseling support through health coach calls and Facebook. Data will be analyzed using an intent-to-treat (ITT) approach where subjects are analyzed according to their treatment assignment at randomization, regardless of level of engagement. The primary outcome is weight loss at 12 months. If successful, the expected results could provide a sustainable, low-cost, postpartum weight loss intervention model for widespread dissemination to reduce disparities in obesity and cardiometabolic comorbidities.

Official Title
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Community-based Obesity Treatment in African American Women After Childbirth: a Randomized Controlled Trial of Women Infant Children (WIC) Mothers

Conditions
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Obesity, Overweight

Intervention / Treatment
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* Behavioral: Community-based obesity treatment (PP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Self-identification as African American Self-report pre-pregnancy BMI between 25-49.9 kg/m2 Measured BMI at baseline between 25-49.9 kg/m2 Philadelphia WIC participant Singleton birth Between 1 and 6 months postpartum Own a cell phone with an unlimited text messaging plan Able to participate in light physical activity (walking) Participants must be willing to comply with all study-related procedures Participants must be able to read and write fluently in English Exclusion Criteria: BMI ≤ 24.9 or ≥ 50.0 kg/m2 Uncontrolled hypertension (systolic blood pressure > 160 or diastolic blood pressure > 95 mmHg). Participants with controlled hypertension on medication for at least three months are allowable. Known atherosclerotic cardiovascular disease Known congestive heart failure Known diabetes mellitus (type 1 or type 2) Known thyroid disease Any major active rheumatologic, pulmonary, hepatic, dermatologic disease or inflammatory condition requiring steroids or immune modulating medications History of testing HIV positive Current smoker or tobacco user. Participants with < 5 cigarettes daily are allowable Current or recent history (past 6 months) of drug or alcohol abuse or dependence Participation in any weight control or investigational drug study within 6 weeks of screening Current consumption of any of the following medications: appetite suppressants, anti-psychotics, lipase inhibitors Serious or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety for successful participation in the study Gastrointestinal Disorders (gallbladder disease, Crohn's disease, etc) Previous weight loss surgery History of bulimia or anorexia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual care (UC)<br>Usual postpartum WIC care | |
| Experimental: Community-based obesity treatment (PP)<br>The PP arm includes expanded obesogenic behavior change goals, tailored skills training materials, interactive self-monitoring text messages, video testimonials, and interpersonal counseling support through health coach calls and Facebook. | Behavioral: Community-based obesity treatment (PP)<br>* Participants in the treatment (PP) arm will receive a 5-component intervention: 1)Behavior change goals; 2)Self-monitoring; 3)Tailored skills training; 4)Video testimonials & 5)Interpersonal counseling. Both treatment and usual care arms will receive the current standard of care offered to postpartum mothers at WIC.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Weight loss (kilograms) | Weight will be measured using a calibrated scale at baseline and 12-month follow-up. Weight loss will be calculated as the difference between mean 12-month and baseline weight in kilograms. | At baseline and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Obesogenic dietary behaviors | Using National Cancer Institute's Diet History Questionnaire, the investigators will assess categories of sugary drink intake, fast/fried food intake, and snacking at baseline and 12-month follow-up. | At baseline and 12 months | 
| Insulin Resistance | Blood will be drawn to assess insulin resistance (insulin and glucose). The Homeostatic model assessment for Insulin Resistance (HOMA-IR) calculation will be used to quantify participant mean insulin resistance at baseline and 12-month follow-up. | At baseline and 12 months | 
| Health-related quality of life | Short Form-12 (SF-12) questionnaire will be used to collect health-related quality of life at baseline and 12-month follow-up. | At baseline and 12 months | 
| Physical Activity | Wrist Actigraphy will be used to measure physical activity (average number of steps) at baseline and 12-month follow-up. | At baseline and 12 months | 
| Physical Activity | Wrist Actigraphy will be used to measure physical activity (average intensity of activity) at baseline and 12-month follow-up. | At baseline and 12 months | 
| Sleep | Wrist Actigraphy will be used to measure sleep (mean duration of sleep) at baseline and 12-month follow-up. | At baseline and 12 months | 
| Sleep | Wrist Actigraphy will be used to measure sleep (mean sleep efficiency) at baseline and 12-month follow-up. | At baseline and 12 months | 
| Sleep | Wrist Actigraphy will be used to measure sleep (mean wake after sleep onset) at baseline and 12-month follow-up. | At baseline and 12 months | 
| Hemoglobin A1c (HbA1c) | Hemoglobin A1c test will be performed by a lab to identify the 3-month average plasma glucose concentration at baseline and 12-month follow-up. The investigators will categorize participants as no diabetes (HbA1c <5.7), prediabetes (HBA1c 5.7-6.4), and diabetes (HBA1c >6.4) at both timepoints. | At baseline and 12 months | 
| Lipids | Total cholesterol test will be performed by a lab to identify mean total blood cholesterol level, low density lipoprotein and high density lipoprotein levels at baseline and 12-month follow-up. | At baseline and 12 months |