Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial

• Published in: JAMA : the journal of the American Medical Association 2017-06, Vol.317 (23), p.2381-2391
• Main Authors: Phelan, Suzanne, Hagobian, Todd, Brannen, Anna, Hatley, Karen E, Schaffner, Andrew, Muñoz-Christian, Karen, Tate, Deborah F
• Format: Article
• Language: English
• Subjects: Adult; Body weight loss; Breast milk; Children; Clinical trials; Coastal environments; Cultural factors; Data collection; Feedback; Female; Food Assistance; Hispanic Americans - statistics & numerical data; Humans; Income; Infants; Internet; Intervention; Low income groups; Messages; Morbidity; Nutrition; Original Investigation; Outcome Assessment, Health Care; Patient Compliance - statistics & numerical data; Patient Education as Topic - economics; Patient Education as Topic - methods; Physical activity; Postpartum; Postpartum period; Postpartum Period - ethnology; Poverty - ethnology; Program Evaluation; Sample Size; Self-Help Groups - organization & administration; Short message service; Single-Blind Method; Statistical analysis; Text Messaging; Weight control; Weight Loss; Womens health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2017.7119

IMPORTANCE: Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. OBJECTIVE: To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. DESIGN, SETTING, AND PARTICIPANTS: A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. INTERVENTIONS: Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. MAIN OUTCOMES AND MEASURES: The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. RESULTS: Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P