Our goal was to promote healthy weight among 480 postpartum overweight and obese Black and Hispanic women currently enrolled in the WIC program in Orange County, Florida. Our objectives included having participants lose between 5 percent and 10 percent or more of the initial body weight; learn to make healthier food choices; and incorporate a minimum of 150 minutes per week of moderate intensity physical activity in their daily lives. Better weight for A Better You (BABY) outcomes achieved as of December 2008 included the following: 94 percent of participants (127) completing the program lost weight, for a total weight loss of 1,577 pounds; average weight loss per woman was 12.4 pounds. Sixty-five percent attained program weight loss goal of at least 5 percent of initial weight.
Participants saw 393 inches decrease in combined waist circumference; the average waist circumference decrease was 3.36 inches per participant. More than one-third (35.1 percent) of participants saw an increase in nutrition knowledge, food choices, and behaviors as evidenced by pre- and post-surveys; there was a 74.4 percent decrease in the number of women who reported regular soda consumption as evidenced by pre- and post–survey. There was a 9.5 percent increase in the number of women who reported water consumption as evidenced by pre- and post–surveys. Most (89.7 percent) participants reported engaging in 30–60 minutes of daily physical activity.
Overweight/obesity studies show that postpartum weight retention is one of the contributors to the obesity epidemic in the United States. According to Crowell (1995), “women who gain excessive weight during pregnancy are at risk for postpartum weight retention and long-term obesity.” In addition Gore, Brown, and West (2003) show that “excessive post-partum weight retention seems to be especially prevalent among minority women.” A study conducted by O’Toole, Sawicki, and Artal (2003) revealed that post-partum women who made a commitment to attend a class in a self-directed intervention “had a high likelihood of successful weight loss that persisted at one year.”
The study also showed that women who were overweight prior to pregnancy were less likely to lose the pregnancy-related weight without a formal intervention. Consequently, the practice addresses overweight and obesity among postpartum Black and Hispanic women and at the same time prevents associated risks faced by women of childbearing age who are overweight and/or obese, such as hypertension, diabetes Type 2, gestational diabetes, coronary heart disease (the number one killer of women), high cholesterol, osteoarthritis, sleep disturbances, breathing problems, and certain cancers. It is also documented that obese and overweight women face increased risks for having babies with abnormalities and other birth defects, thus emphasizing the need for healthy weight preconceptually (Watkins et. al, 2003). Not only is this intervention necessary among overweight and/or obese post-partum women, but more so among those who are members of racial and ethnic minority populations among whom the prevalence of overweight and obesity is higher than in non-Hispanic White women. We identified the rising trend of overweight/obesity among Black and Hispanic women in Orange County, Florida, and confirmed our suspicions by analyzing the 2002 County Behavior Risk Factor Surveillance System (BRFSS) Survey, which showed 21.7 percent of Black women and 26.3 percent of Hispanic women were considered overweight and 43.8 percent of Black women and 20.4 percent of Hispanic women were considered obese compared to 20.2 percent overweight and 22 percent obese White women (Bureau of Epidemiology, Florida Department of Health).
In addition, this was further identified among participants of the Women, Infants and Children Supplemental Food Program (WIC) in 2003 where 66 percent of postpartum Black women were overweight and 35 percent were obese. Similarly, 62 percent of the postpartum Hispanic women were overweight and 28 percent were obese. This is indicative of the well-documented health disparities among these minority groups. In addition, the Black and Hispanic population in Orange County, Florida, has continued to increase from 37 percent in 2000 to 45.1 percent in 2007 (U.S. Census). The practice addresses the issue by providing 25 weeks of class sessions using a modified version of the highly successful Diabetes Prevention Program (DPP) lifestyle intervention curriculum, Lifestyle Balance (Diabetes Care, 2002). In addition, there is a physical activity component using a DVD format with culturally appropriate music and participants are encouraged to engage in physical activity of like intensity at least five times per week. Participants meet once per week for two hours in community centers close to their residence. In our literature review prior to the creation and development of the BABY Program, we were not able to find any research that addressed how to manage postpartum overweight/obesity in minority women (Black and Hispanic). In addition, there were only a few articles that discussed postpartum overweight/obesity. At the time of our review, this population appeared not to have been addressed by the scientific community. Furthermore, nobody in the United States had targeted overweight/obese postpartum minority women. This has been such a novel idea that we have presented in more than twenty-tw
Agency Community RolesThe Orange County Health Department (OCHD) supported the BABY Program by providing in-kind contributions and by promoting and advocating it at the local and state level. A special meeting was arranged between the OCHD director, assistant directors , BABY’s director and coordinator with the State of Florida Surgeon General, Dr. Ana M. Viamonte Ros, and her staff. In addition, OCHD provided space for the general recruitment sessions and for a few of the intervention sessions. This was a collaborative effort between the Orange County WIC Program, the Office of Minority Health, Florida WIC Program, Orange County Health Department, and the City and County’s Parks and Recreation Division. Participant recruitment was conducted through an internal referral process from the WIC clinics and a query of potential participants from the WIC State Office.
The Parks and Recreation Division of both the City of Orlando and Orange County provided the use of the community centers and kitchens where the weekly BABY sessions took place. Both the Orange County Health Department and the WIC Program provided invaluable in-kind contributions and the Office of Community Health director, Yolanda G. Martinez, Ph.D., was the co-grant writer of the project/practice. OCHD encourages and supports participation with our community partners and it has advocated for the BABY program to the Winter Park Health Foundation (WPHF). This culminated in a collaborative effort between WPHF, the East Central Health Council, other community partners and OCHD to apply for a CDC grant proposal where BABY is one of the major interventions. This proposal has been accepted and is currently awaiting funding once the “Stimulus Package” is distributed. This will continue to provide funding to reach a larger number of participants through WIC and clients of the Primary Care Access Network in Orange County.
Costs and ExpendituresStart-up cost: $145,000 year one; implementation: $145,000 per year; in-kind contributions: $60,000 per year.
ImplementationThe intervention consisted of 25 weeks of class sessions using a modified version of the highly successful Diabetes Prevention Program (DPP) lifestyle intervention program curriculum, Lifestyle Balance (Diabetes Care, 2002). In addition, there was a physical activity component using a DVD format with culturally appropriate music. Participants were encouraged to engage in physical activity of like intensity at least five times per week. New groups of participants were recruited every six months to participate in BABY. Each group consisted of six subgroups (two subgroups of Black women and four subgroups of Hispanic women, 15–20 participants each). Each subgroup met once per week for a two-hour session for six months. Morning and evening sessions were offered. Also, sessions were conducted in English and/or Spanish. Participant recruitment was conducted by a query of overweight/obese Black and Hispanic postpartum clients in Orange County WIC and by an internal referral form within WIC clinics. Women who have delivered at least eight weeks prior to initiation of the intervention were invited to participate in an introductory recruitment session. Participants attending the recruitment session completed a series of screening forms, such as PAR-Q & You (Physical Activity Readiness Questionnaire), to determine readiness. Other tools were used to determine medical or psychiatric conditions that would be barriers for weight loss or detrimental to participants’ health. Furthermore, recruitment attendees also completed the BECK Depression Inventory to assess risk for depression.
Also, weight and height were obtained for each participant to determine current BMI. The recruitment data required determining participants’ eligibility criteria were gathered through a general survey. Participants were asked to sign a consent form and a liability release form. A Lifestyle Coach of same racial/ethnic background as the participants conducted the intervention sessions. During the first week of the intervention, the following parameters were gathered: weight, height, waist circumference, blood pressure, an initial survey, and a commitment contract. Also, a detailed description of the intervention was provided and participants received measuring cups and spoons. During subsequent weeks, the weight of each participant was obtained once per week and recorded. During week 25, post-data gathering took place and included blood pressure, weight, height, waist circumference, and a satisfaction survey. Also, there was a “graduation party” where certificates of completion and gifts donated by the community were provided.
Due to the excellent results and the fact that the BABY Program is a lifestyle change prevention program combating the number one public health epidemic in the nation, OCHD is very interested and supportive to perpetuate its implementation. This was demonstrated by the meeting between the OCHD director, assistant directors, the BABY director, BABY coordinator, and the Florida Surgeon General, Dr. Ana M. Viamonte Ros, and her staff in Tallahassee, Florida in April 2007. At this time, it was decided that a Legislative Budget Request (LBR) would be in order to fund this program completely and discussions also included the roll out of the program to other counties in Florida.
Unfortunately, the state of Florida began to have a multitude of financial problems prior to the current national financial crisis and petitions for new programs were suspended. However, OCHD continues to be supportive and has agreed to continue to provide in-kind services to support the program. In addition, OCHD director, Dr. Kevin Sherin, has also advocated for the BABY Program with community partners to collaborate in grant writing efforts and to search for funding opportunities. In the same manner, the WIC program has continued to provide in-kind services. It is our hope that the new emphasis of the federal administration in prevention, wellness, and medical care will make funds available to support our efforts in Orange County, Florida.
At this time, the plan of action to sustain the practice includes the following: submit a minimum of three grant proposals per year; market the BABY Program to corporations and businesses on a fee for service basis; advocate to the state for legislative funding when the financial atmosphere improves in Tallahassee, Florida. Once the current state and national financial crisis has ended we hope to obtain funding from the state and the federal government to totally sustain the BABY Program.