The postpartum period represents a critical opportunity for socioeconomically disadvantaged women to experience or avoid excess weight gain and new or persistent obesity. Even for the same amount of weight gain in pregnancy, medically vulnerable mothers (e.g., those who are low-income and often racial/ethnic minorities) have significantly higher body mass indices at the end of the first postpartum year than their higher income, predominately Caucasian counterparts.1–3 Efforts to promote postpartum weight loss in extant clinical trials of these high risk mothers, however, have proven to be exceedingly challenging. Traditional approaches using strict caloric and activity targets or meal replacements, delivered through repeated in-person group visits, have been unsuccessful, largely because of the complexity and inherent resource needs (e.g., transportation, childcare, costs) associated with these strategies.4–6
Dr. Gilmore et al. article in this month's Journal of Women's Health evaluates the preliminary efficacy of a novel, Smartphone-based intervention to promote postpartum weight loss among low-income mothers enrolled in the Women, Infants, and Children food and nutrition program.7 Mobile health (mHealth) technologies are appealing for promoting postpartum weight loss as they offer considerable flexibility due to their continuous and immediate proximity, are lower cost than face-to-face treatments, and enjoy high penetration among socioeconomically disadvantaged racial/ethnic minorities—populations who are the most likely to own mobile devices and use advanced data functions (e.g., sending/receiving email, text messages, video, and pictures).8,9 However, the mHealth intervention tested in this study failed to achieve clinically significant weight loss. While mothers who were more adherent to the intervention were more likely to lose weight over the 16-week trial than those randomized to usual care, few mothers had high intervention adherence (n = 5).
Do mHealth interventions still hold promise for delivery of postpartum weight loss interventions among medically vulnerable mothers? The jury is still out. Perhaps the addition of social media to offer peer support, as we have implemented in the past with preliminary success, is necessary for enhanced engagement.10 Pairing mHealth interventions with trusted care providers (e.g., nutritionists at the Women, Infants and Children program) as interventionists/health coaches, integrated into routine care, may be needed to reliably produce clinically significant outcomes and sustain effects. More research is necessary to determine the most effective scalable approach for weight loss in these high risk mothers—work that has the potential to halt the vicious cycle of obesity and cardiometabolic disease from one generation to the next.
Acknowledgment
This study was supported by NHLBI R01HL130816.
References
- 1.Boardley DJ, Sargent RG, Coker AL, Hussey JR, Sharpe PA. The relationship between diet, activity, and other factors, and postpartum weight change by race. Obstet Gynecol 1995;86:834–838 [DOI] [PubMed] [Google Scholar]
- 2.Parker JD, Abrams B. Differences in postpartum weight retention between black and white mothers. Obstet Gynecol 1993;81:768–774 [PubMed] [Google Scholar]
- 3.Walker LO, Freeland-Graves JH, Milani T, et al. Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: II. Trends and correlates. Women Health 2004;40:19–34 [DOI] [PubMed] [Google Scholar]
- 4.Results and lessons learned from a prevention of weight gain program for low-income overweight and obese young mothers: Mothers in motion. BMC Public Health 2017;17:182. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Ostbye T, Krause KM, Lovelady CA, et al. Active mothers postpartum: A randomized controlled weight-loss intervention trial. Am J Prev Med 2009;37:173–180 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Walker LO, Sterling BS, Latimer L, Kim S-H, Garcia AA, Fowles ER. Ethnic-specific weight-loss interventions for low-income postpartum women: Findings and lessons. Western J Nurs Res 2012;34:654–676 [DOI] [PubMed] [Google Scholar]
- 7.Gilmore LA, Klempel MC, Martin CK, et al. Personalized mobile health intervention for health and weight loss in postpartum women receiving women, infants, and children benefit: A randomized controlled pilot study. J Womens Health 2017;26:719–727 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Bennett GG, Steinberg DM, Stoute C, et al. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: A systematic review. Obes Rev 2014;15 Suppl 4:146–158 [DOI] [PubMed] [Google Scholar]
- 9.Smith A. U.S. Smartphone use in 2015. Available at: www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/ Accessed January15, 2017
- 10.Herring SJ, Cruice JF, Bennett GG, Davey A, Foster GD. Using technology to promote postpartum weight loss in urban, low-Income mothers: A pilot randomized controlled trial. J Nutr Educ Behav 2014;46:610–615 [DOI] [PMC free article] [PubMed] [Google Scholar]